The Colombo Plan Drug Advisory Programme (DAP) Training Series

Universal Prevention Curriculum for Substance Use (UPC)

Managers and Supervisors Series

Participant Manual

Course 05
School-Based
Prevention Interventions
The Colombo Plan Drug Advisory Programme (DAP) Training

Managers and Supervisors Series

Series Universal Prevention Curriculum for Substance Use (UPC)
Managers and Supervisors Series

School-Based Prevention
Interventions

Participant Manual

April 2020 Edition

 Acknowledgments
Managers and Supervisors Course 5: School-Based Prevention Interventions is part of
a nine-volume Universal Prevention Curriculum for Substance Use (UPC) training series
developed for the Bureau of International Narcotics and Law Enforcement Affairs (INL),
U.S. Department of State.
Special thanks go to Thomas Browne, CEO, Colombo Plan, and Brian Morales, Branch
Chief, Office of Global Programs and Policies, Bureau of International Narcotics and
Law Enforcement Affairs, US Department of State, for their guidance and leadership
throughout the project’s development. From APSI, Zili Sloboda served as Project Director
and Lead Curriculum Developer, and Susan B. David served as Curriculum Developer.
Other members of the Curriculum Development Team contracted by APSI include J.
Douglas Coatsworth, William Crano, Rebekah Hersch, Chris Ringwalt and Richard Spoth
(See Appendix E).
We would like to thank the Expert Advisory Group members for their expertise in reviewing
the course content for the 2015 edition (See Appendix F). Their invaluable contribution
helped to ensure the quality of the final product.
Dr Josephine Choong, Project Manager - Curriculum Development (Prevention)
contributed significantly to the development of this publication.
Special thanks are extended to the pilot-test group members (see Appendix G) who
provided invaluable input for the first edition of this course. Their enthusiastic participation
and creativity contributed greatly to the finished product.

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Managers and Supervisors Course 05: School-based Prevention Interventions
CONTENTS

Part I—Participant Orientation

Participant Orientation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Part II—Training Modules

Module 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Module 1—Training Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Module 2—Why Schools Are an Important Setting for Substance
Use Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Module 3—Child and Adolescent Development . . . . . . . . . . . . . . . . . . . 81
Module 4—Defining the Substance Use Problem for Prevention
Planning in Schools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Module 5—Applying Theory to School-Based Substance Use
Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Module 6—Selecting and Adapting the Right Prevention
Program for Your School . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
Module 7—School Environment and School Policies . . . . . . . . . . . . . . . 317
Module 8—Monitoring and Evaluation of School-Based
Prevention Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . 351
Module 9—Review of School-Based Prevention Interventions:
Application to Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383

Part III—Appendices
Appendix A—Learner-Centered Trainer Skills: A Brief Overview . . . . . . 389
Appendix B—Dealing with Difficult Participants during Training . . . . . . 391
Appendix C—Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Appendix D—Resources
Citations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401
Appendix E—Curriculum Developers . . . . . . . . . . . . . . . . . . . . . . . . . . . 407
Appendix F—Expert Advisory Group . . . . . . . . . . . . . . . . . . . . . . . . . . . 409
Appendix G—Special Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . 411

iii
 Public Domain and Dissemination Notice
All Universal Curricula (UC) materials appearing in this course except for those taken
directly from copyrighted sources are in the public domain and may be reproduced,
or copied by Training Providers (TPs) and their trainees without permission from the
U.S. Department of State/INL or the authors. Trainer manuals and trainer PowerPoint
slides may only be shared with designated Training Providers (TP)s and their authorized
users (e.g. TP training team members and administrators). To become a Training
Provider, a government, university, or civil society organization may contact a Regional
Coordinating Center to request access. Access is granted after the duly-filled Training
Provider Application Form is approved. The directory of current Training Providers is
available at: https://www.issup.net/training/education-providers
TPs may disseminate either the entire curriculum series, one or more entire courses,
or one or more entire modules. In these cases, all TPs are required to document any
UC training on the ISSUP website. TPs are also welcome to incorporate UC materials
into their own academic/training materials. In these cases, citation of the source is
appreciated.
This publication may not be distributed for a fee beyond the cost of reproduction
without specific, written authorization from INL.
Disclaimer
The substance use prevention interventions described or referred to, herein, do not
necessarily reflect the official position of INL or the U.S. Department of State. The
guidelines in this document should not be considered substitutes for individualized
client care.

April 2020 Edition

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Managers and Supervisors Course 05: School-based Prevention Interventions
PARTICIPANT ORIENTATION
Introduction
Welcome! This training will provide you with a comprehensive overview of over 20 years
of research on substance use prevention and how it can be applied in the “real world” of
prevention practice worldwide. Psychoactive substance use and substance use disorders
(SUDs) continue to be major problems around the world, taking a toll on global health
and on social and economic functioning. Learning about evidence-based prevention can
provide you with valuable, effective tools, which can make a difference in intervening with
affected populations in your country and community.
Congratulations for taking the time to become educated about the latest approaches to
substance use prevention available today!

This Training
Managers and Supervisors Course 05: School-Based Prevention Interventions is part of
a training series developed through funding from the U.S. Department of State to The
Colombo Plan for the Drug Advisory Programme (DAP). Information about DAP can
be found at http://www.colombo-plan.org.The overall goal of the training series is to
reduce the significant health, social, and economic problems associated with substance
use throughout the world by building international prevention capacity through training,
professionalizing, and expanding the substance use prevention workforce.
Who is it for: This curriculum series is designed to provide extensive foundational
knowledge to Prevention Managers and Supervisors about the most effective evidence-
based (EB)prevention interventions that are currently available. Prevention Managers
and Supervisors, usually located at the community, state or country level, are prevention
professionals involved in the assessment and planning for prevention, organization,
selection and implementation of EB interventions, and monitoring and evaluation of
programming. Current plans include a follow-up series directed at Prevention Practitioners
working in programs with a greater focus on building skills to deliver these EB interventions
at the direct service level.
The nine modules in this training course may be delivered over six consecutive days (most
often), or may be offered over the course of several weeks. Your trainers have provided
you with a specific agenda.
The learning approach for the training series includes:
„ Trainer-led presentations and discussions;
„ Frequent use of creative learner-directed activities, such as small-group and partner-
to-partner interactions;
„ Small-group exercises and presentations;

1
Participant Manual: Participant Orientation
 „ Reflective writing exercises;
„ Periodic reviews to enhance retention; and
„ Learning assessment exercises.
Your active participation is essential to making this a positive and productive learning
experience!

Goals and Objectives for Course 5

Training goals
„ To provide an overview of the opportunities that schools provide for drug prevention;
„ To develop participants’ understanding of matching students’ developmental stages
to prevention programs and strategies;
„ To assist participants in getting started in schools;
„ To provide an overview of the principles of effective and ineffective prevention practice
in school settings – of what works and what does not work;
„ To teach participants how to negotiate registries of evidence-based practice and
select the prevention course that is right for their school;
„ To provide an overview of issues pertaining to implementation fidelity and adaptation;
and
„ To develop participants’ understanding of effective drug prevention policies and
whole school prevention programs.

Learning objectives
Participants who complete Course 5 will be able to:
„ Make a persuasive case of why it is important to integrate drug prevention strategies
into school settings;
„ Describe the importance, and provide examples, of matching prevention strategies to
students’ developmental stages;
„ Specify the nature and progression of youths’ use of substances;
„ Specify five examples each of effective and ineffective prevention practice in school
settings;
„ Describe a registry of effective prevention programs and practices and how to use the
registry to select an appropriate prevention strategy;

2
Managers and Supervisors Course 05: School-based Prevention Interventions
„ Explain the importance of maintaining and monitoring fidelity to course guides when
implementing drug prevention programs; and
„ Develop a model alcohol, tobacco, and other drug policy that includes both prevention
and early intervention.

Training materials
Training materials include:
„ This Participant Manual. Please be sure to bring your manuals for each session; it has
valuable materials to help you follow along with the program. Sections include:
• Introduction to each module – At the beginning of each module, we will set aside
approximately 5 minutes for you to review this introduction on your own; it will
highlight the content of the module and touch on the major concepts to be covered.
• Training goals and learning objectives for each module
• A timeline
• Power Point slides with lines for taking notes.
• Resource Pages; these pages have information you’ll need for exercises, information
to read later, or exercise instructions.
• Summary of the module expanding on the introduction with citations for future
reference.
• Appendix A – Glossary
• Appendix B – Resources
„ Notebook for use as a journal and for making note of ideas you want to return to, later
on. These might include:
• Topics you would like to read more about;
• A principle you would like to think more about;
• Ways you might be able to add some of the ways you are learning to your practice;
• Possible barriers to implementing new practices;
• Questions you want to ask the trainers before the training ends.
„ International Standards for Drug Use Prevention – a copy of the PDF saved in a flash
drive for your use and review. This document was produced by the United Nations
Office of Drugs and Crime (UNODC) to serve as a guide for policy-makers on the
concept of ‘evidence-based’ prevention interventions and policies. This publication
also serves as the basic foundation of this curriculum series, which is designed to

3
Participant Manual: Participant Orientation
 help prevention practitioners put into practice the knowledge gleaned from more
than 20 years of prevention research. This document will also help as a resource as we
proceed through this course in understanding prevention science and its implications
for prevention service delivery.
„ The European Drug Prevention Quality Standards is a joint production by the
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and the
Prevention Standards Partnership, and presents and describes basic and expert level
quality standards for substance use prevention. The standards cover all aspects of
substance use prevention work, including needs and resource assessment, program
planning, intervention design, resource management, implementation, monitoring and
evaluation, dissemination, sustainability, stakeholder involvement, staff development,
and ethics. Since this is a very large document, it is best to order a free copy directly
from the EMCDDA at URL: http://www.emcdda.europa.eu/publications/manuals/
prevention-standards .

Getting the Most from Your Training Experience

To get the most from your training experience:
„ If you have a supervisor, speak to him or her before the training begins. Find out what
his or her expectations are for you.
„ Think about what you want to learn from each module.
„ Come to each session prepared; review the manual pages for the modules to be
presented—especially the Introduction which sets the stage for the module content.
„ Be an active participant: Participate in the exercises, ask questions, write in your
journal, and think about what additional information you want to know.
„ Speak to your supervisor (or co-workers, if you have no supervisor) after the training.
Talk about what you learned to be sure you understand how the information relates
to your job.
„ Discuss with your supervisor or co-workers ways that you can put your learning into
practice, and continue to follow up on your progress.
„ Have fun!

4
Managers and Supervisors Course 05: School-based Prevention Interventions
 MODULE 0
U.S. DEPARTMENT OF STATE

5
Participant Manual: Module 0 - U.S. Department of State
 -1-

Congratulations!

³ As a participant in this training, you are part of a rapidly

growing global community of substance use professionals

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0.2

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Managers and Supervisors Course 05: School-based Prevention Interventions
 How is this global community of substance use
professionals expanding?
In the last decade, a growing number of people are:
9 being trained
9 being credentialed
9 studying at universities with specialized addiction
programs
9 operating in the context of a larger drug control
system
9 adhering to science and research-based approaches
9 joining professional substance use associations
9 networking through professional associations

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0.3

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Participant Manual: Module 0 - U.S. Department of State
 Who are the members of this global community of
substance use professionals?

Individuals working worldwide in the substance

use prevention and treatment fields in
government, non-governmental organizations,
civil society, and the private sector

Organizations that act as portals or

“doorways” for individuals to join the
global community

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0.4

ISSUP stands for the International Society of Substance

Use Professionals
9 ISSUP was launched by INL in 2015 as a global, not for
profit, non-governmental organization to
professionalize the global prevention and treatment
workforce.
9 ISSUP provides members with opportunities to share
knowledge, exchange experiences, and stay abreast
with current research in the field

Cont.
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0.5

8
Managers and Supervisors Course 05: School-based Prevention Interventions
 ISSUP stands for the International Society of Substance Use
Professionals

9 There are more than 10,000

ISSUP members worldwide
9 Join one of ISSUPs four levels
of membership for free at:
www.issup.net
9 You can earn credit for this
and other courses with ISSUP

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0.6

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Participant Manual: Module 0 - U.S. Department of State
 ICUDDR stands for the International Consortium of
Universities for Drug Demand Reduction
9 Global consortium of universities to promote academic
programs that focus on science-based prevention and
treatment
9 Collaborative forum for individuals and organizations to
support and share curricula, particularly this Universal
Curriculum series, and experiences in the teaching and
training of prevention and treatment knowledge

Cont.
-7-
0.7

ICUDDR stands for the International Consortium of Universities

for Drug Demand Reduction

Learn about specialized addiction programs at universities

worldwide at www.icuddr.com

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10
Managers and Supervisors Course 05: School-based Prevention Interventions
 GCCC stands for the Global Centre for Credentialing and
Certification of Addiction Professionals
9 The hours that you put into this training can be logged
at GCCC and qualify you for exams and professional
credentials
9 GCCC credentials will help accelerate your career by
indicating your passion and commitment to high
standards

Cont.
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0.9

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Participant Manual: Module 0 - U.S. Department of State
 GCCC stands for the Global Centre for Credentialing and
Certification of Addiction Professionals

Learn about how to apply the latest in research-based

prevention and treatment at: www.globalccc.org
-10-
0.10

Who funds and supports this

global community of substance
use professionals?
The U.S. Department of State’s
Bureau of International Narcotics
and Law Enforcement Affairs (INL)
which is funded by the U.S. taxpayer

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Managers and Supervisors Course 05: School-based Prevention Interventions
 Where does this global community of substance use
professionals meet?
9 Digitally- through ISSUP and its networks and
9 Face to face – through trainings, on university campus
settings, and at conferences held at the global, national
regional and local levels

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13
Participant Manual: Module 0 - U.S. Department of State
 How does this global community of substance use
professionals operate?
In the context of a larger international drug control
environment that includes:
ƒ United Nation’s three international Drug Control
Treaties or “Conventions”
ƒ Commission on Narcotic Drugs (CND)
ƒ International Narcotics Control Board (INCB)

-13-
0.13

What are the key international organizations which operate

in the context of this larger drug control environment?

The Colombo Plan Drug Advisory Program (DAP)

The Inter-American Drug Abuse Control
Commission (CICAD) of the Organization of
American States (OAS)

The African Union Commission (AUC)

The United Nations Office on Drugs and Crime

(UNODC)

The World Health Organization (WHO)

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Managers and Supervisors Course 05: School-based Prevention Interventions
 How can I participate in this global community of substance use
professionals?
The easiest way is to become an active member of ISSUP!
9 Register for free on the ISSUP website at www.issup.net
9 Click on the “Apply for Membership” icon
9 Select one of four levels of membership -all are free!
9 Begin networking with others on an ongoing basis
It takes only a few minutes to register and you can immediately
connect with over 10,000 ISSUP members worldwide!

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0.15

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Participant Manual: Module 0 - U.S. Department of State
 What are the benefits of being an active member of this
global community of substance use professionals?
You can:
9 Stay informed
9 Implement best practices
9 Access training and mentoring
9 Turn training into credentials
9 Access job postings
9 Access up-to-date research
9 Join a professional network
9 Interact with other professional networks

-16-
0.16

CALL TO ACTION
Next Steps Participate in ISSUP
1. Join ISSUP at ¾ Post on ISSUP: Find easy
www.issup.net instructions for how to
2. Complete this training to post on the ISSUP website
earn credit ¾ Engage ISSUP’s Networks:
3. Send your credit hours to Connect with colleagues
GCCC at www.globalccc.org and broaden your impact

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Managers and Supervisors Course 05: School-based Prevention Interventions
 MODULE 1
TRAINING INTRODUCTION

Content and timeline. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Training goals and learning objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
PowerPoint slides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Resource page. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

17
Participant Manual: Module 1—Training Introduction
18
Managers and Supervisors Course 05: School-based Prevention Interventions
Content and Timeline
Person
Activity Time
Responsible
Module 0 30 minutes
Ceremonial Welcome 30 minutes
Trainer welcome, housekeeping, and ground rules 15 minutes
Partner exercise: Introductions 60 minutes
Break 15 minutes
Presentation: Training materials 15 minutes
Why this training? 15 minutes
Large-group exercise: Training expectations 15 minutes
Small-group exercise: The role of schools in the
45 minutes
community
Lunch 60 minutes
Total Time = 300 minutes (5 hours)

Module 1 Objectives
Learning objectives
Participants who complete Module 1 will be able to:
„ Explain the overall training goals and at least four objectives of the 5-day training;
„ State at least one personal learning goal; and
„ Briefly describe why it is important to integrate evidence-based prevention programs
and policies into school settings.

19
Participant Manual: Module 1—Training Introduction
 The Colombo Plan Drug Advisory Programme (DAP) Training Series
Universal Prevention Curriculum for Substance Use (UPC) Managers and Supervisors Series

Managers and Supervisors

Course 05
School-Based Prevention
Interventions

MODULE 1—TRAINING INTRODUCTION



Learning Objectives

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Managers and Supervisors Course 05: School-based Prevention Interventions
 Partner Exercise: Introduction

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Participant Manual: Module 1—Training Introduction
 Training Materials

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22
Managers and Supervisors Course 05: School-based Prevention Interventions
 Prevalence of Substance Use (18-29 Year
Olds)

Country Tobacco Alcohol T&A Cannabis Other drugs Other Drugs

W/Cannabis Initiations
Colombia 49.1 96.1 96.8 14.4 7.2 42.2

Mexico 64.4 91.5 92.1 11.5 9.6 58.3

USA 74.4 96.2 96.0 57.6 27.3 12.6

Belgium í 88.4 88.4 31.0 10.2 8.7

France í 94.5 94.5 52.9 11.0 21.7

Italy í 79.6 79.6 17.4 1.1 27.0

Netherlands í 92.6 92.6 38.9 15.5 40.7

Ukraine 81.1 99.7 99.4 15.2 2.6 32.1

Nigeria 9.0 62.1 63.1 3.1 0.4 93.1

South Africa 33.1 45.5 52.0 12.7 3.0 51.1

China 49.3 78.7 84.0 1.4 0.6 í

Japan í 97.2 97.2 4.5 4.8 77.3

New Zealand í 95.4 95.4 63.0 23.6 7.0

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23
Participant Manual: Module 1—Training Introduction
 Why is Prevention of Health and Social
Problems Important for any Nation?

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Managers and Supervisors Course 05: School-based Prevention Interventions
 Managers and Supervisors : The Face of
Prevention

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Participant Manual: Module 1—Training Introduction
 Training Series Goal

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26
Managers and Supervisors Course 05: School-based Prevention Interventions
 Overarching Themes (2/2)

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Participant Manual: Module 1—Training Introduction
 Curricula in the Series

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Managers and Supervisors Course 05: School-based Prevention Interventions
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Managers and Supervisors Course 05: School-based Prevention Interventions
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Participant Manual: Module 1—Training Introduction
 Small-group Exercise: Role of Schools in
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36
Managers and Supervisors Course 05: School-based Prevention Interventions
Resource Page 1.1: Colombo Plan Drug Advisory Programme
(DAP) Training Series, Universal Prevention Curriculum for
Substance Use (UPC) Managers and Supervisors Series

Course 1: Introduction to Prevention Science (5 days)

„ Foundational and basic knowledge; and
„ Overviews the science that underlies evidence-based prevention interventions and
strategies and the application of these effective approaches in prevention practice.
Course 2: Physiology and Pharmacology for Prevention Professionals (3 days)
„ Foundational and basic knowledge, not skills-based; and
„ Overview of the physiology and pharmacology of psychoactive substances and their
effects on the brain to affect mood, cognition, and behavior, and the consequences
of such use on the individual, the family, and the community.
Course 3: Monitoring and Evaluation of Prevention Interventions and Policies (5 days)
„ Skills-based; and
„ Describes the primary evaluation methods used to measure evidence-based substance
use prevention interventions; provides guidance in applying them to “real-world”
prevention settings.
Managers and Supervisors Course 04: Family-based Prevention Interventions (4 days)
„ Foundational and basic knowledge; and
„ Overviews the family as the primary socialization agent of children, the science behind
family-based prevention interventions, and the application of such evidence-based
approaches to help prevent the onset of substance use in children.
Managers and Supervisors Course 05: School-based Prevention Interventions (6 days)
„ Foundational and basic knowledge; and
„ Overviews the school in society, the science behind school-based prevention
interventions, and the application of such evidence-based approaches in school
settings around the world.
Managers and Supervisors Course 06: Workplace-based Prevention Interventions (4 days)
„ Foundational and basic knowledge; and
„ Overviews the role of work and the workplace in society, how stresses and other work-
related influences affect people’s risk of substance use, the science behind workplace
prevention interventions, and the application of such evidence-based approaches in
work settings around the world.

37
Participant Manual: Module 1—Training Introduction
 Managers and Supervisors Course 07: Environment-based Prevention Interventions (3
days)
„ Foundational and basic knowledge; and skills-based; and
„ Overviews the science underlying evidence-based substance use prevention
environmental interventions, involving policy and community-wide strategies.
Managers and Supervisors Course 08: Media-based Prevention Interventions (3 days)
„ Foundational and basic knowledge; and skills-based; and
„ Overviews the science underlying the use of media for substance use prevention
interventions.
Managers and Supervisors Course 09: Community-based Prevention Implementation
Systems (5 days)
„ Foundational and skills-based; and
„ Overviews the science underlying systems approach to prevention interventions;
presents exemplars of evidence-based substance use prevention systems; and
provides guidance on developing such approaches.

38
Managers and Supervisors Course 05: School-based Prevention Interventions
Resource Page 1.2: Overarching Themes of the Universal
Prevention Curriculum for Substance Use (UPC) Managers
and Supervisors Series

There are several significant themes that need to be stressed throughout the UPC series.
The first is the definition of substance use, which includes the use of tobacco and alcohol
(which are usually illegal for children), the illegal drugs of abuse, inhalants and the non-
medical use of prescription medications.
Another theme is the science of prevention, which has shown how substance use has
affected individuals, families, schools, communities, and countries; and how it can be
addressed with effective strategies, policies and interventions. This is likely to be a new
concept for most of the participants in your training. That is one of the reasons why the
United Nations Office on Drugs and Crime conducted a thorough review of prevention
science to identify the most effective approaches to prevention that can have the strongest
impact on the population.
Those effective interventions, also known as evidence-based (EB) prevention
interventions and policies, are now available for implementation. This training is
designed to help prevention practitioners select those interventions and policies that
most likely address community need, implement these interventions and policies, and
monitor the quality of the implementation and the outcomes for the participants.
The science has also explained the developmental nature of substance use and similar
behavioral problems. This requires an understanding of how to intervene at various ages,
starting with very young children, progressing through the more vulnerable teenage and
young adult years, and continuing throughout the lifespan.
Another theme is that substance use and other problem behaviors are generally the
result of negative interactions between environmental factors and the characteristics
of individuals. EB prevention practices are designed to positively intervene in these
different environments—e.g., the family, school, workplace, and community-wide. That is
why we are producing curricula designed to assist prevention professionals in all of these
settings.
Trained prevention professionals also need to be knowledgeable in a wide range
of disciplines, including epidemiology, pharmacology, psychology, counseling, and
education. They will learn how to apply these skills to assess the nature and extent
of substance use in their area, identify the populations most at-risk, and select which
interventions are needed to make a difference.
They will also learn how to bring people together, analyze data, persuade stakeholders
of the value of EB programs and policies, and implement, monitor, and evaluate the
outcomes of these EB efforts.
THE OVERALL CURRICULUM SERIES THEME IS TO CREATE LEADERS IN EVIDENCE-
BASED PREVENTION IN COUNTRIES AROUND THE WORLD.

39
Participant Manual: Module 1—Training Introduction
 Resource Page 1.3: U. S. Society for Prevention Research:
Principles of Prevention Science

„ Developmental focus, which means that, as prevention professionals, we need to

understand that there are variations in the factors that influence behaviors as they
occur over the life course. It also means that, in any society, there are developmental
or age-related tasks that need to be accomplished as children grow. Any disruption of
the accomplishment of these tasks may lead to the occurrence of disorders or problem
behaviors at certain stages of development. All of this needs to be considered as we
look at potential prevention interventions we want to use in our efforts to prevent the
onset of drug use and its consequences.
„ Developmental epidemiology of the target population plays a critical role in
prevention. We recognize how transitions through different ages place children
at varying risks—e.g., a child’s transition from spending most of the time at home
and with caretakers, to spending most of the time in school. But we also need to
acknowledge the differences in factors related to the use of psychoactive substances
and outcomes within and across populations, this means that the factors or processes
leading to initiate substance use and to continue use vary across individuals, groups,
and populations. Such heterogeneity is critical to understanding risk variations in
processes and mechanisms that are reflected in intervention design.
„ Transactional ecological factors refer to the various environmental influences on
our beliefs, values and attitudes and behaviors. This includes the interaction of the
characteristics of the individual, family, school, community, and the larger socio-
political and physical environments. These interactions not only influence our beliefs,
attitudes, and behavior, but also are interdependent, affecting each other. Within
this overall framework, prevention science draws from a wide range of theories that
explain the dynamics of human development and behavior.
„ Human motivation and change processes focuses on human motivation and change
processes. Understanding these processes helps design effective interventions which
seek change in individuals and environments to prevent or treat substance use. Many
factors play a role in influencing behaviors and impacting decision-making, including
deciding not to use psychoactive substances or engage in other high-risk behaviors.
„ The transdisciplinary nature of prevention science means that we need to involve
transdisciplinary teams with an array of expertise to address the complexity of the
issues addressed by prevention science. This expertise includes understanding the
etiology of a range of problem behaviors; intervention development and practice
expertise; knowledge of research design, sampling and data collection and analysis,
as well as understanding program and policy implementation and analysis.
„ Professional ethical standards are based on values. Values are the basic beliefs that an
individual thinks to be true and are also seen as guiding principles in one’s life or the
bases on which an individual makes a decision. Clearly, the work of prevention involves
decisions, in regards to the treatment of others, in the most important settings of their

40
Managers and Supervisors Course 05: School-based Prevention Interventions
 lives—family, school and workplace. But it also involves the community environment
where policies and laws dictate legal and illegal behavior. The prevention practitioner
needs to be guided by ethics and values that can help in these challenging areas of
life. We will go into detail about professional ethics in prevention in Module 6, but
these guide all aspects of prevention science.
„ Continuous feedback between theoretical and empirical investigations seeks to
explain the mechanisms that account for a behavioral outcome discovered through
empirical epidemiological investigations or evaluations of prevention interventions.
„ Improving public health is a vision that prevention science can serve through the
collaborative work of prevention scientists and community prevention practitioners
using their collective skills and particular expertise. Science, practice and policy must
be mutually informed by research in controlled and natural settings.
„ Social Justice is related to the Human Rights Movement and the Health as a Right
Movement. Social Justice is the ethical and moral imperative to understand why
certain population subgroups have a disproportionate burden of disease, disability,
and death, and to design and implement prevention programs and systems and policy
changes to address the root causes of inequities.

41
Participant Manual: Module 1—Training Introduction
 Resource Page 1.4: Small-group Exercise: Role of Schools in
the Community

Country/Region/ School Types: Children’s Ages Prevention:

City EL (Grades 1-5/6); Yes/No
MS (Grades 6-8/9); If No, Why
HS (Grades 9/10-12)

42
Managers and Supervisors Course 05: School-based Prevention Interventions
Summary of Module 1: Training Introduction
Global substance use problem
Psychoactive substance use and substance use disorders (SUDs) continue to be major
problems around the world, taking a toll on global health and on social and economic
functioning. The United Nations Office on Drugs and Crime (UNODC) reports that, in
2012, 162 to 324 million people between ages 15 and 64 used illicit substances at least
once. Of these about 10-14% will develop substance use problems.
Illicit substances in the survey included opioids, cannabis, cocaine, other amphetamine-
type stimulants, hallucinogens, and ecstasy, among others.
In addition, the World Health Organization (WHO) estimates that there are 2 billion
alcohol users and 1.3 billion smokers. Tobacco use and alcohol use are the second and
eighth leading causes of death and third and sixth leading causes of years of life lost due
to premature death and to disability. WHO also estimates that approximately 12% of all
deaths are attributable to tobacco and alcohol use. In addition to deaths, the number of
years of life lost due to premature mortality (early death) and due to living with disability
(called Disability Adjusted Life Years-DALYs) amount to 8% of total years of life lost
attributable to tobacco and alcohol use.
Substance use varies across the world. A study conducted internationally by a team
of epidemiologists with support from the World Health Organization found that most
countries have high rates of combined alcohol and tobacco use among 18-29 year olds.
The use of cannabis and other drugs varied across the world with New Zealand and the
USA leading with 87% and 85%, respectively and China and Japan reporting the lowest
rates of 2% and 9%, respectively.

Why is prevention important?

There is growing recognition that health not only has a direct impact on human welfare, but
also is related to raising income levels through: worker productivity, children’s education,
savings and investment, demographic structure.
Substance use prevention stops people from beginning to use drugs and other
psychoactive substances, and can help those who have started to avoid progressing
to substance abuse and substance use disorders. But substance use prevention has a
broader intent: the healthy and safe development of children and youth to realize their
talents and potential. It does this by helping them positively engage with families, schools,
peers, workplace and communities.
But prevention has to work if it is to help. And that only happens if evidence-based
substance use prevention interventions and policies are implemented. What we mean
is, we are taking what we have learned in research to apply it in the “real-world” of
communities so we can be more successful in preventing problem behaviors that
impede healthy growth.

43
Participant Manual: Module 1—Training Introduction
 The training series
This course is part of a training series developed through funding from the U.S. Department
of State to The Colombo Plan for the Drug Advisory Programme (DAP). The overall goal of
the training series is to reduce the health, social, and economic problems associated with
substance use by building international prevention capacity through training about the
most effective evidence-based prevention interventions and strategies, professionalizing
the Prevention Manager and Supervisor and Prevention Practitioner standards, and
expanding the global prevention workforce. This curriculum series focuses on applying
the key findings reported in the International Standards for Drug Use Prevention to “real-
world” communities around the globe.

44
Managers and Supervisors Course 05: School-based Prevention Interventions
 MODULE 2
WHY SCHOOLS ARE AN IMPORTANT SETTING FOR
SUBSTANCE USE PREVENTION

Content and timeline. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Training goals and learning objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Introduction to module 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
PowerPoint slides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Resource page. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

45
Participant Manual: Module 2—Why Schools Are an Important Setting for Substance
Use Prevention
 Content and Timeline
Person
Activity Time
Responsible
Introduction to Module 2 15 minutes
Presentation and discussion: Role of schools: Beyond
30 minutes
cognition
Small-group exercise: Micro-level environmental
50 minutes
interactions
Break 15 minutes
Presentation and discussion: Risk and protective
30 minutes
factors framework
Presentation and discussion: Socialization is key 15 minutes
Presentation: School culture and climate 15 minutes
Large-group discussion: Socially capable students 30 minutes
Wrap-up 15 minutes
End of Day 1
Presentation: School culture and climate (continued) 15 minutes
Individual exercise: Positive school climate 30 minutes
Presentation: Schools and prevention 15 minutes
Large-group discussion: Key points for prevention 15 minutes
Challenges to prevention and reflections 15 minutes
Module 2 evaluation 15 minutes
Break 15 minutes
Total Time = 335 minutes (5 hours 35 minutes)

Module 2 Objectives
Learning objectives
Participants who complete Module 2 will be able to:
„ Describe why the school is important as a setting for substance use prevention;
„ Discuss the importance of the school’s culture and climate as a foundation for academic
achievement and substance use prevention; and
„ Specify three key roles that schools can play in substance use prevention.

46
Managers and Supervisors Course 05: School-based Prevention Interventions
Introduction to Module 2
Module 2 introduces the concept that schools provide the second most important setting
for prevention beyond the family. Their role in most societies is to help prepare children
and youth to become fully contributing members of families, workplaces, communities,
and society. Their educational mission is to build the cognitive skills of children while
socializing them to the culture, values, and other societal guides for behavior in their
community.
But, while schools’ primary role is educating youth, the school environment also plays
an important role in providing a safe and supportive culture and climate that promotes
prosocial attitudes and behaviors. You will be reminded of the Etiology Model, which
shows how children interact with the school environment like other micro-environments
in ways that can increase or decrease their potential risk for substance use and other
problem behaviors. These interactions shape children’s and youth’s values, beliefs,
attitudes, and behaviors, and are particularly important to the physical, emotional, and
social development from childhood to adolescence, and then from adolescence to
adulthood. The school can influence how children and youth perceive the acceptability
and unacceptability of various positive and negative behaviors.
You will learn more about the socialization of children which is the lifelong process by which
culturally-appropriate and acceptable values, attitudes, norms, beliefs, and behaviors are
transferred and internalized. Socialization is shaped by a variety of influences. One of
them is the extent to which the child bonds to the institutions that are responsible for the
socialization process – including families and schools. The other is the extent to which
these institutions fulfill their responsibilities as primary socializers.
Lastly, you will learn about the role of schools in regard to substance use prevention.
Their primary role is in the area of demand reduction, which helps prevent children from
engaging in substance use by instilling anti-substance use values, norms, beliefs and
attitudes, and by giving them the skills to say “no” effectively to peers who may invite
them to use substances. Schools also have some responsibility for supply reduction–
that is, developing clear and consistently enforced policies targeting the use and sale of
all substances. Third, schools have a responsibility to their students to reduce the adverse
consequences associated with use by providing access to counseling and treatment if
needed.

47
Participant Manual: Module 2—Why Schools Are an Important Setting for Substance
Use Prevention
 The Colombo Plan Drug Advisory Programme (DAP) Training Series
Universal Prevention Curriculum for Substance Use (UPC) Managers and Supervisors Series

Managers and Supervisors

Course 05
School-Based Prevention
Interventions

MODULE 2—WHY SCHOOLS ARE AN

IMPORTANT SETTING FOR
SUBSTANCE USE PREVENTION



Introduction



48
Managers and Supervisors Course 05: School-based Prevention Interventions
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Participant Manual: Module 2—Why Schools Are an Important Setting for Substance
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 Role of Schools: Beyond
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 Cognitive Skills

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Participant Manual: Module 2—Why Schools Are an Important Setting for Substance
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 School Interventions Work within the Micro-Environment
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Community Institutions Affect Each Other



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Managers and Supervisors Course 05: School-based Prevention Interventions
 Micro-Level Environments: Primary
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Participant Manual: Module 2—Why Schools Are an Important Setting for Substance
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Participant Manual: Module 2—Why Schools Are an Important Setting for Substance
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Participant Manual: Module 2—Why Schools Are an Important Setting for Substance
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Participant Manual: Module 2—Why Schools Are an Important Setting for Substance
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Managers and Supervisors Course 05: School-based Prevention Interventions
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Managers and Supervisors Course 05: School-based Prevention Interventions
Resource Page 2.1: Making the Case for Substance Use
Prevention

„ Schools are the best venues for child and adolescent substance use prevention:

• Because that’s where the children are

• Since most children go to school, prevention messages can reach a large population
of young people
• Messages delivered to universal populations can be delivered without stigma
• Universal prevention programs reach everyone, including youth at low and high risk

„ Effective substance use prevention programs have been linked to academic

achievement and dropout prevention: Important objectives for all schools.

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Participant Manual: Module 2—Why Schools Are an Important Setting for Substance
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 Summary of Module 2: Why Schools Are an Important
Setting for Substance Use Prevention
Schools and Cognitive Skills
Schools come in all shapes and sizes and configurations, but almost every country has a
school that is given the role of preparing children and youth to become fully contributing
members of their families, workplaces, communities, and their society. However, schools
and education accomplish much more than this. A 2007 World Bank Policy Report
(Hanushek & Wößmann, 2007) found through analyses of educational data and national
economies that: “there is strong evidence that the cognitive skills of the population –
rather than mere school attainment – are powerfully related to individual earnings, to
the distribution of income, and to economic growth.” Cognitive skills address students’
ability to:
„ Think for themselves and to address problems in a reasoned and carefully considered
fashion, both alone and in collaboration with others.
„ Reason, conceptualize, and solve problems using unfamiliar information or new
procedures.
„ Draw conclusions and come up with solutions by analyzing the relationships among
given problems, issues, or conditions.
The World Bank report continues: “International comparisons incorporating expanded
data on cognitive skills reveal much larger skill deficits in developing countries than are
generally derived from just school enrollment and [academic achievement or] attainment.
The magnitude of change needed makes clear that closing the economic gap with
developed countries will require major structural changes in schooling institutions.” The
changes suggested may require such measures as:
„ Increasing budgets for public schools;
„ Ensuring that all students, regardless of economic status or gender, have access to at
least a high school education; reducing class sizes;
„ Developing students’ skills related to the analysis of the information they are taught,
as opposed to learning it by rote;
„ Increasing teachers’ pay and educational expectations; and
„ Offering meals – both breakfast and lunch – in communities whose students may be
likely to come to school hungry.
Schools should do considerably more than just teach students information and improve
their cognitive skills. The school like the family is one of the micro-level environments
that serve as key institutions that shape children’s development and their prosocial
attitudes and behavior. There are many complex interactions among the biological,
personal, social, and environmental characteristics that affect human behavior. These

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Managers and Supervisors Course 05: School-based Prevention Interventions
interactions shape children’s and youth’s values, beliefs, attitudes, and behaviors, and are
particularly important to the physical, emotional, and social development from childhood
to adolescence, and then from adolescence to adulthood. The school can influence how
children and youth perceive the acceptability and unacceptability of various positive and
negative behaviors. So, school interventions can affect an individual’s vulnerability to and
risk for problem behaviors in general, and substance use in particular.
Prevention professionals need to view their community in a holistic fashion, understanding
the interrelationships among each of its many parts. This is not particularly easy to do,
because many of us are used to thinking about these various institutions in isolation from
one another. In Course 1 you were introduced to the key micro-level environments that
constitute the primary socialization agents in any society. “Socialization” means the lifelong
process of learning, integrating, and expressing the norms, rules, and customs that govern
people’s interactions with one another and allow them to live together harmoniously
and productively. In society, the institutions primarily responsibility for the socialization
of children and youth include family, peers, school, faith-based organizations, and the
workplace. All of these agents influence one another as well as children, adolescents,
and adults. That is, they all reinforce one another’s effects on various stages of human
development. Ideally, they all complement one another to support healthy, prosocial, and
successful citizens and thus produce a harmonious and productive society.

Risk and Protective Factors Framework

There are positive and negative influences on children’s development in the school
and other settings that need to be understood. In this regard, the ‘risk and protective
factor’ framework is particularly helpful in explaining negative or risk behaviors, and has
informed prevention programming for the past 25 years. The framework suggests a host of
characteristics pertinent to an individual’s genetic inheritance and intra-personal, physical,
and social environments that individually and collectively increase the risk that they will
engage in risky behaviors. The framework also suggests that there are characteristics in
these various environments that protect against the effects of risk factors – that is, make
it less likely that an individual will engage in them, and more likely that they will behave
in appropriate and healthy ways. This framework is certainly appealing. For example,
children who grow up in households where alcohol abuse is a problem are likely to be
at increased risk of alcohol abuse themselves, for any of a variety of reasons (including
availability, socialization, and genetic predisposition).
On the other hand, children who come from very supportive and warm families may be
less likely to use alcohol. Many factors have been identified in the literature as potential
determinants of risk behaviors, including, for example, low self-esteem, high levels of
impulsivity, and delinquent peers.
There has always been concern that some risk and protective factors are only indicators
(or correlates) of other mechanisms and processes that are directly responsible for
risk behaviors. The problem with using this approach is that if you design a preventive
intervention to target these indicators (or correlates), you may fail to address the real
underlying mechanisms or causes for youth’s substance use behavior. These mechanisms
have only begun to be understood in the last decade or so.

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Participant Manual: Module 2—Why Schools Are an Important Setting for Substance
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 Socialization Is Key
Recent results of research into neurobiology and genetics indicate the level of
developmental competencies that children achieve is related to their susceptibility or
vulnerability to the engagement in these behaviors. Such engagement is the result of
an interaction between individual vulnerability (and protection) and environmental
influences. Children may be vulnerable, but if they are raised in warm, loving families with
caregivers who provide appropriate socialization—e.g., good parenting and supervision,
they will be protected from engaging in behaviors that are potentially harmful including
substance use. Schools and the school experience may also serve to protect vulnerable
youth. The experience may also put some at risk. Indeed, recent research indicates that
failed socialization—caused by, for example, poor parenting, disorganized and unsafe
neighborhoods, or bad schools—is directly related to engaging in unhealthy behaviors,
as are poor decision-making skills. That is why the most important ingredients in evidence-
based interventions in schools are the components that build positive socialization and
good decision-making skills to prevent the onset of substance use and other problem
behaviors.
As background, socialization (Clausen, 1968) is the lifelong process by which culturally
appropriate and acceptable values, attitudes, norms, beliefs, and behaviors are transferred
and internalized. Socialization is shaped by a variety of influences. One of them is the
extent to which the child bonds to the institutions that are responsible for the socialization
process – including families and schools. The other is the extent to which these institutions
fulfill their responsibilities in this regard. Some families and schools do – and other don’t.
Peers, too, can (and do) serve as very strong socialization agents, especially as children
enter adolescence and then adulthood – and, as such, their multiple influences can be
either (or both) positive and negative.
With the exception of their own homes, most children spend more time at school than
anywhere else. Schools and other educational institutions have a particular responsibility
for the children enrolled in them: To teach students what they need to know to become
fully functional and independent citizens as adults; and to fulfill the responsibilities
that are required of them at home and in the workplace. In so doing schools reinforce
the positive behaviors that children learn at home and in the community. Schools are
thus society’s most important agent of socialization outside of the family. Indeed, when
families experience problems or because work limits the amount of time parents can
spend with their children, schools may become the prime agent of socialization. For many
schools around the world, this is a very large responsibility that they have neither the time
nor resources to assume, but they must do the best they can with it. Schools are also
in an excellent position to help students develop negative attitudes towards all illegal
behaviors – including substance use – and to strengthen their positive attitudes towards
prosocial behaviors. Students in preschool settings, as well as those in lower and middle
schools are under almost constant adult supervision, which provides school staff with
an exceptional opportunity to shape youths’ behaviors by rewarding their appropriate
behavior and intervening when they see antisocial behavior.

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Managers and Supervisors Course 05: School-based Prevention Interventions
School Culture and Climate
Every school, of course, is much greater than the sum of its physical parts, or even the
teachers and staff who work in them. Each school has many important characteristics
that shape its students’ behaviors. The school’s setting for example can affect whether
the students feel – and are – safe and healthy in that environment. Is it appropriately
equipped with the materials and tools students need to learn? Do they feel safe in
traveling to and from school? Are programs and policies available that directly affect
health and risk behaviors such as substance use prevention? School culture and climate
(Osher and Boccanfuso, 2011) refer to the quality and character of the school and school
life, and are made up of many interrelated components.

Students’ Perception of Safety and Support

These include, among many others, students’ perceptions of physical and emotional
safety at school, connections to caring, respectful, and dedicated teachers and staff, and
engagement in meaningful and rewarding activities. School culture and climate are also
related to school bonding, since schools with a positive culture and climate are much more
likely to have students who are psychologically attached to them, and school bonding is
necessary if the school’s socialization function is to be successfully realized.
Schools with a positive climate and culture have a shared vision to which everyone
contributes. Much research has been conducted on these very intangible notions; one set
of researchers has concluded that the key aspects of school climate that are most linked to
students’ academic achievement are their perceptions of safety and support (Bogdan, et
al., 2013; Hyde, et al., 2013, 2013, 2011, 2011; Trentacosta, 2009), the degree to which they
are challenged, and the extent to which they consider themselves socially competent and
capable. Students must also believe that their school has rigorous academic standards
and high expectations of them. They should feel challenged, invested, and motivated to
succeed, and appreciate the relationship between their academic achievement at school
and their life goals. Students should be emotionally intelligent, which means having the
ability to identify, assess, and control one’s own emotions, and to understand and assess
the emotions of others, both singly and in groups. Finally, an effective school is one in
which students are given meaningful opportunities to contribute to the welfare of the
school.
Students cannot learn if they feel unsafe in their school environment. Their physical safety
is just the beginning. That is, in many schools students and faculty may live with the threat
of violence and aggressive or delinquent behavior. Included in the threat of violence is
both sexual coercion and harassment, as it relates to both girls and boys. Thus, students
need to know that they are safe from the threat of any kind of psychological or emotional
harm or sexual violation or harassment, from either peers or staff. In addition, they must
feel socially safe – which means that they are in an environment that does not allow,
and takes active steps to prevent or stop, bullying and teasing. Teasing and bullying are
now taking a wide variety of forms, including the use of electronic media like Facebook
and Twitter to send harassing text and pictures. A discussion of the prevention of these
behaviors, which are increasing rapidly as these media become more widely available, is
well beyond the scope of this course. However, schools should assume responsibility for

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Participant Manual: Module 2—Why Schools Are an Important Setting for Substance
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 the prevention of a wide array of behaviors that may compromise their students’ physical
and mental health – not just substance use.
Students must also believe that they are fairly and equitably treated by those in authority
over them. That is, they should be able to feel that school administrators and teachers
treat all students in the same manner, and that none get favorable treatment because of
their special status – for example, because they are outstanding athletes or students, or
belong to one or another racial or ethnic group. Further, the school must be orderly, that
is, there should be clear rules of and expectations related to behaviors that are known
to all. For example, students should not be concerned that they may be punished for
breaking a rule – such as coming late to class, or threatening another student - that is
inconsistently enforced. Thus all rules should apply equally to all students. We will return
to this theme again in a later module in this series when we discuss the importance of
consistent and impartial enforcement of policies related to substance use.
Finally, students must feel that they are supported. Their feelings of safety and security at
school come in part from being well-connected to a social network, or web, that includes
both peers and school staff. Students should also feel a strong attachment to their school,
insofar as they know their place and role in the school and enjoy positive relationships with
teachers and peers. In addition, they should know where and to whom to turn for help
when they need it, and how to access it. They should expect that the help they receive
will be given them in a thoughtful, sensitive, and respectful fashion that ensures their
rights of confidentiality, and that it will help them respond effectively to the problems and
adversities they face.

Poor School Climate

It sometimes seems easier to describe what a school climate should not be than what
it should be – just like it is easier to describe what schools should not do in regards to
substance use prevention than what they should do. Many schools with problems and
issues are very easy to spot almost as soon as you walk in the door. The hallways may be
dirty or in disrepair. Students may wander through the halls during classroom periods.
There may be graffiti on the outside walls. Students at such schools may be listless,
apathetic, or otherwise isolated in their own worlds – that is, they are disengaged from
one another – and do not seem to value the education they are receiving. They may feel
physically or psychologically threatened; bullying, jostling, teasing, and sexual harassment
are pervasive, and the presence of gangs may make parts of the school grounds and
surrounding community unsafe.
In such schools, the emphasis may be on discipline as opposed to academic
accomplishment. Teachers concentrate more on keeping order in their classroom than
in teaching course material. Or teachers give up, and surrender control of their class
altogether to their students. They feel depressed and stressed (Hammen and DeMayo,
1982), and also believe that there is little they can do motivate their students or teach
them course content; some manifest what has been called “learned helplessness.”
Learned helplessness (Peterson, 1993) which is a concept taken from the study of animal
psychology, occurs when an animal is repeatedly subjected to a negative condition – such
as an electric shock – from which it is not allowed to escape. Eventually, the animal will

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Managers and Supervisors Course 05: School-based Prevention Interventions
stop trying to avoid the condition and will behave as if it is utterly helpless to change its
situation. This concept can also apply to situations involving human beings. When people
feel that they have no control over their environments, and that these environments are
threatening and unstructured, they may feel hopeless because they feel that they cannot
make a difference and just give up. In such environments, school policies related to student
behavior are generally poorly understood or arbitrarily applied, and consequences for
infractions are inconsistent and may favor one group or type of student over another.

Schools and Prevention

Schools thus have a vital role to play in the prevention of substance use. The primary
responsibility that schools can assume to prevent substance use is to create and maintain
a positive school climate with the characteristics mentioned above. But schools have a
major role to play in substance use prevention in at least three additional key areas.
The first is demand reduction: that is, preventing or at least delaying youths’ substance
use by attempting to instill anti-substance use values, norms, beliefs and attitudes, and
by giving them the skills to say “no” effectively to peers who may invite them to use
substances. Most school-based programs have demand reduction as their primary, and
often exclusive, goal. Schools also have some responsibility for supply reduction– that
is, developing reasonable, clear and consistently enforced policies targeting the use and
sale of all substances, including alcohol and tobacco, on and near school grounds and
at all school-sponsored events. Third, schools have a responsibility to their students to
reduce the adverse consequences associated with use. Schools can treat students who
are problem users with sensitivity and compassion, by referring them to appropriate
counseling and treatment, and by helping them stop using and remain substance free.
This responsibility is often characterized in the public health field as either secondary or
tertiary prevention.
Schools can begin teaching students, from a very young age, the dangers of exposure
to second-hand smoke and of riding with an adult or peer who is under the influence of
psychoactive substances. Older children can also be taught a repertoire of behaviors to
successfully avoid situations where they may be invited to ride with a driver who has been
drinking.
For children and adolescents, the two prime sites for substance use prevention are the
family and the school. Indeed, many children are likely to spend more time at school than
with both – or even, either – parent. Further, many families are too preoccupied with or
physically and emotionally depleted by the daily necessities of providing an income – of
putting food on the table and paying the rent – to be able to provide their children with
effective guidance concerning avoiding risk behaviors in general, and substance use in
particular. A further advantage of schools is that messages can be delivered to all children
(as a universal population) – and not just to those who are in a high risk group (a selective
population) or who are demonstrating signs and symptoms of substance use (an indicated
population). All children do need to be exposed to such messages, since all children face
some degree of risk. Further, messages delivered to all youth can be delivered without
stigma – without, that is, identifying and isolating youth who have already begun to use.
Indeed, placing such youth in a high risk group (Poulin, 2001) has been shown to increase
risk behaviors by all the youth.

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Participant Manual: Module 2—Why Schools Are an Important Setting for Substance
Use Prevention
 The tremendous progress of prevention science in demonstrating the effectiveness of
evidence-based preventive interventions in preventing substance use; but these efforts
have also shown success in producing academic achievement and preventing dropouts
( Gasper, 2011)—two major academic goals. So, Prevention Managers and Supervisors
have to be able to make the case that it is in the schools,’ as well as, their students’ best
interests to make time for substance use prevention.

References
Bogdan, R. et al. (2013). A neurogenetics approach to understanding individual differences
in brain, behavior, and risk for psychopathology. Molecular Psychiatry, 18, 288-299.
Clausen, J. A. (1968). Socialization and society. Boston, MA: Little Brown & Company.
Gasper, J. (2011). Revisiting the relationship between adolescent substance use and high
school dropout. Journal of substance Use Issues, 41(4), 587.
Hammen, C.L., & DeMayo, R. (1982). Cognitive correlates of teacher stress and depressive
symptoms: Implications for attributional models of depression. Journal of Abnormal
Psychology, 91(2), 96.
Hanushek, E.A. & Wößmann, L. (2007). The Role of Education Quality in Economic Growth.
World Bank Policy Research Working Paper 4122. Available at:
https://openknowledge.worldbank.org/bitstream/handle/10986/7154/wps4122.
pdf?sequence=1
Hyde, L.W. et al. (2011). Perceived social support moderates the link between threat-
related amygdala reactivity and trait anxiety. Neuropsychologia, 49, 651-656.
Hyde, L.W. et al. (2011). Understanding risk for psychopathology through imaging gene-
environment interactions. Trends in Cognitive Science, 15, 417-427.
Hyde, L.W. et al. (2013). Dimensions of callousness in early childhood: Links to problem
behavior and family intervention effectiveness. Development and Psychopathology, 25,
347-363.
Kellam, S.G., Branch, J.D., Agrawal, K.C., & Ensminger, M.E. (1975). Mental health and
going to school. The Woodlawn program of assessment, early intervention and evaluation.
Chicago: University of Chicago Press, Chicago Press.
Osher, D., & Boccanfuso, C. (2011). Making the case for school climate and its measurement.
Available at: http://safesupportivelearning.ed.gov/sites/default/files/sssta/20110303_
PresentationFinal21011SSSTASchoolClimateWebinarpublic.pdf
Peterson, C. (1993). Learned helplessness. John Wiley & Sons, Inc.
Poulin, F. et al. (2001). 3-year iatrogenic effects associated with aggregating high-risk
adolescents in cognitive-behavioral preventive interventions. Applied developmental
science, 5(4), 214-224.
Trentacosta, C. J. et al. (2009). Adolescent dispositions for antisocial behavior in context:
the roles of neighborhood dangerousness and parental knowledge. Journal of Abnormal
Psychology, 118, 564-75

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 MODULE 3
CHILD AND ADOLESCENT DEVELOPMENT

Content and timeline. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Training goals and learning objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Introduction to module 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
PowerPoint slides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Resource page. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

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Participant Manual: Module 3—Child and Adolescent Development
 Content and Timeline
Person
Activity Time
Responsible
Introduction to Module 3 15 minutes
Presentation and discussion: Understanding human
30 minutes
development
Presentation: Interaction of personal characteristics
20 minutes
and the environments
Presentation and discussion: Learning and theories:
30 minutes
Cognition
Lunch 60 minutes
Presentation and discussion: Learning and theories:
45 minutes
Motivation
Presentation and discussion: Learning and theories:
45 minutes
Maslow’s human needs hierarchy
Break 15 minutes
Presentation: Development periods and skills 30 minutes
Individual exercise and large-group discussion:
30 minutes
Developmental skills
Presentation: Revisiting substance use etiology model 15 minutes
Small-group exercise: Etiologic factors in communities 45 minutes
Presentation and discussion: School prevention
15 minutes
objectives
Summary and reflections 20 minutes
Module 3 evaluation and wrap-up 15 minutes
End of Day 2
Total Time = 430 minutes (7 hours 10 minutes)

Module 3 Objectives
Learning objectives
Participants who complete Module 3 will be able to:
„ Specify three general skills related to each of three developmental periods:
• Middle Childhood;
• Early Adolescence; and
• Adolescence.

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Managers and Supervisors Course 05: School-based Prevention Interventions
„ Specify three skills related to substance use prevention from each of these three
developmental periods

Introduction to Module 3
Module 3 provides an overview of child and adolescent development as a primary focus of
prevention science. We will look at the developmental differences in children’s cognitive,
emotional, and language abilities at different ages which will help to clarify issues of
vulnerability to substance use.
It is important for prevention professionals to learn about age-related benchmarks
because they help to explain variations in vulnerability to engaging in behaviors such
as substance use that have negative health consequences. Also, understanding human
development, particularly cognitive development, provides guidance as to how best
to intervene effectively with age-appropriate prevention messages to reach the target
group.
This module summarizes a brief history of cognitive and learning theories to help you
see how prevention interventions evolved. Cognitive theories (originating with Piaget)
suggest that there are four stages in the developing child: Sensorimotor (0-2 years) when
children start to explore their world; preoperational (2-6 years) when children begin to
use words and images; concrete operational (7-12 years) when children begin to think
logically; formal operational (12 years to adulthood) when adolescents can reason and
think abstractly.
Learning theories will introduce you to Benjamin Bloom’s domains of cognitive,
affective, and psychomotor processes where learning at the highest level of each domain
is dependent upon having achieved the prerequisite knowledge and skills at the lower
levels, so that each domain builds on the domains underneath it. You will also hear
about spiraling, which is a teaching concept which integrates old and new information
which was introduced by Bruner in the 1960s. Maslow’s Hierarchy of Needs lays out the
physiological and social needs of children and adolescents and how those relate to at-risk
behaviors.
Module 3 will also discuss the developmental periods of middle childhood, early
adolescence, and adolescence, and young adulthood. It will talk about the types of
knowledge and skills children will acquire at each age, as well as the prosocial behaviors.
It will provide a contrast of the cognitive, emotional, and social differences among these
age groups.
The last section of the module will present an overview of the specific prevention objectives
that address each age group.

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Participant Manual: Module 3—Child and Adolescent Development
 The Colombo Plan Drug Advisory Programme (DAP) Training Series
Universal Prevention Curriculum for Substance Use (UPC) Managers and Supervisors Series

Managers and Supervisors

Course 05
School-Based Prevention
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MODULE 3—CHILD AND ADOLESCENT

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Participant Manual: Module 3—Child and Adolescent Development
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Participant Manual: Module 3—Child and Adolescent Development
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 Matching Prevention Programs to
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 School Prevention
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 Child Development and School-Based
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 Module 3 Evaluation
15 minutes


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Managers and Supervisors Course 05: School-based Prevention Interventions
 Resource Page 3.1: Developmental Stages 3-16 Years

Social Language Physical Intellectual Emotional Behavioral

3-4 Years Shares, plays Recites Thread beads, Build a tower, Can wait for Ability to
well with others, numbers but use scissors, paint, draw needs to be bargain but not
will play alone, can only count tiptoes, can a head for a fulfilled, sense reason, uses
use spoon/fork to 3, converses, pedal and steer, person, holds a of humor, imagination,
to eat, personal recites rhymes balance, spatial pencil properly understands fear of dark and
hygiene and songs, has awareness past and abandonment,
favorite story present enjoys humor
5-7 Years Shares, applies Enjoys stories Construction Copy letters, Caring about Expresses anger
imagination to and applies toys, coloring, counts on friends and and frustration
play, dresses them to play, games, play ball fingers, adds babies, better less with action
and undresses understands games, dances, details to control of and more with
double hops, skips pictures, aware conduct and words, more
meaning of of time behavior independent
words
8-12 Years Independent Reading and Variation Talk about Learn by Join clubs and
from parents, writing, more in physical thoughts and observation associate more
sense of right articulate, holds appearance feelings, thinks and talking, with peers, want
and wrong, conversations, more notable, more logically, give support acceptance of
sense of future can debate, early puberty in develop math in stressful peers
relates events girls, improved and literacy times, able to

Participant Manual: Module 3—Child and Adolescent Development

eye-hand skills emphasize
coordination
13-16 Years More time with Clarity of Puberty for both More concern Experiencing Increases desire
peers, form thinking, sexes, rapid for others and hormonal for privacy,
identity, test expression of musculoskeletal community, changes, more time with
limits, more own beliefs growth, question and preparing for peers
adult role increased challenge rules, independence
models stamina explore new from family,
ideas acting out

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 Summary of Module 3: Child and Adolescent
Development
Understanding Human Development
In general, human beings all over the world develop very much the same way, particularly
children. Early attachment to care-givers occurs almost immediately after birth. Babies
all begin to sit up when they are around six months old and begin to walk up-right when
they are about one year old. They rapidly mature and become more attuned to their own
needs and to interact with their immediate world. The progress made by children in the
first two years of life is universal and amazing.
Developmental domains that are monitored by parents, extended family, and health
professionals include children’s cognitive or intellectual characteristics, physical
development, acquisition of social skills, and emotional growth. Although these domains
develop independently they are very much interconnected. Child development is
an important focus of prevention science as it serves to help us understand issues of
vulnerability, as well as, how children learn best, which shapes the content, structure, and
delivery of prevention interventions. Learning is a natural part of human development and
is not only informed by children’s needs and abilities to understand their environment but
also by their interaction with other humans in their environment. Although parents and
caregivers have a major influence on children throughout life, the school experience also
is significant in any society to prepare children to assume their roles as adolescents and
later as adults.
We have already mentioned the brain and how substances effect how the brain functions.
A key part of the brain involved in the development of problem behaviors like substance
use is the last to develop! Between the ages of 5 and 20, there are key changes in the
maturity of those areas of the brain that are associated with executive functions. This
is the front part of the brain, which includes decision-making, planning, awareness of
time and skills, the evaluation of new ideas, engagement with others, and controlling
impulsivity. These areas are the most involved in the perception of future consequences,
social interactions, and judgments and decisions leading to behavioral problems.
Understanding human development, and specifically age-related benchmarks, is
important for prevention for two major reasons. First, knowledge about human
development helps us understand variations in vulnerability to engaging in behaviors
that have negative consequences such as substance use. Second, understanding human
development, particularly cognitive development, provides guidance as to how best to
intervene effectively to prevent these negative behaviors. Prevention professionals should
understand these developmental differences as the delivery of prevention messages that
should be tailored to the target group and their ability to participate in the prevention
intervention. This ability not only includes their cognitive and language development but
also the emotional and social experiences that are necessary to apply the information
they learn to their own lives and physical and social environments.

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Vulnerability to engaging in behaviors that may have negative health and social
consequences such as substance use, in general, means having the potential or being
susceptible to being hurt or harmed. And in the prior module we talked about vulnerability
and socialization. People are vulnerable at some points in their lives; when they transition
from one situation to another such as changing schools, moving away from the parental
home, getting married, having children, starting a new job. Each change means new
situations, new rules and responsibilities, new ideas all leading to stress. Coping is
dependent on having the knowledge and skill set that helps to evaluate the challenges,
make decisions as to how best to deal with them, and acting appropriately for oneself
and within the expectations of those around them. People are vulnerable if they haven’t
met the developmental benchmarks or never learned these skills in the first place. Coping
skills may vary from making prosocial accommodations to losing one’s temper to walking
away or to using alcohol or some other substance to ‘get them through.’

Interaction of Personal Characteristics and the Micro- and

Macro-level Environments
Now, what is known from epidemiologic studies of the origins of negative behaviors
such as substance use? Epidemiologic studies have shown that initiating substance
use involves an interaction between individual personal characteristics such as genetic
predisposition, temperament, and personality type, as well as, differences in how one
actually sees, hears, and experiences the surrounding physical and social environment.
The environment has been categorized into micro-and macro-levels. The micro-level
environments involve the family, peers, and school. The macro-level environments, on
the other hand, include the larger physical and social environment that would include
things such as neighborhood poverty, decay, criminal behavior, and high tolerance of
substance use, as well as, opportunities to access such protective resources as social
services. It is the interaction between individual vulnerability and the micro-and macro-
level environments that establishes risk.
How does this interaction work? You can think of the personal characteristics like light
switches that can be either “on” or “off” and then think of environmental factors as
dials that can negatively or positively impact risk for engagement in behaviors. So if we
have children with learning disabilities who are exposed to a negative environmental
experience such as adversity, the dials are ramped up and risk is increased. But for these
same children experiencing a positive environment such as being raised in a warm and
nurturing family, the dials are turned down and risk is decreased. No factor alone is
sufficient to cause substance use; there is likely some critical combination of the number
and types of switches that are on or off, and dials that are turned up or down, that crosses
a liability threshold, in essence priming the brain for abuse and addiction. Finally, there
are environmental dials that provide resiliency and may counteract or reduce the effect of
genetic switches that are on.

Micro-level Influences
Some of these micro-level influences are parents and families. They nurture and keep
children safe; they provide social and emotional regulatory skills; teach children about
sharing and reciprocity; and reinforce societal norms, values and behaviors. Parents and

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 the family are important throughout our life. Peers are important, more so as children
enter adolescence. Peers contribute uniquely and independently from family factors in the
socialization process and can be considered one of the primary engines of development
for children. Positive adult development including marriage is very much influenced by
friendship patterns over time and particularly in adolescence. Children’s choice of peers
is therefore important. After the family and peers, the next major micro-level influence
in a society is the school and/or other education-related groups (such as guilds or
apprenticeships). The school provides the needed skills so that children can transition
from childhood to assume their expected adult roles.
Schools also reinforce values, norms, and acceptable societal behaviors. A child’s
attachment to school is a component of resilience, suggesting that effective and responsive
teachers, an evidence-based course, classroom reinforcements, positive school culture,
opportunities for school participation, and maintaining school building structures may
play an important role in positive development.

Learning and Theories

We have already discussed the importance of human development to prevention
through understanding that failure to achieve developmental benchmarks can make us
vulnerable to negative behaviors such as substance use. But human development also
has implications for how we acquire new knowledge, develop new ideas, acquire new
skills, and learn how to deal with life under good and stressful situations.

Cognitive Theories
This understanding draws on cognitive theory and science, which focus on human
thought processes. The early work of Jean Piaget from the 1920s still influences current
understanding of cognitive processes. His most revolutionary premise was that children
think quite differently from adults. Some general concepts from Piaget’s and other works
suggest that children build their knowledge through their observation of the world around
them and by manipulating objects they find. They learn much on their own through these
observations and ‘experiments’. And further, children are intrinsically motivated to learn.
Cognitive theory suggests that there are four major developmental stages of cognitive
development.
1. Sensorimotor (0-2 years) when infants explore their worlds through their senses and
motor contact.
2. Preoperational (2-6 years) when children begin to use words and images to represent
objects but lack the skills to think logically
3. Concrete operational (7-12 years) when children begin to think logically about concrete
objects
4. Formal operational (12 years to adulthood) when adolescents can reason and think
abstractly.
Although Piaget’s work has come under criticism, it remains influential today. From research
conducted in the 1970s by Renner and colleagues, it has been found that although the

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stages remain important, there is some variation within each age group. That is, students
do not move in lockstep from one stage to another as they get older; at any age, some
students may be operating in an earlier stage and some at a later one. So, for example, at
age 8 about one-quarter of the students studied were in the preoperational stage, over
half were in the onset concrete stage, and another quarter had advanced to the formal
concrete stage.

Learning Theories
A number of other educational psychologists have contributed to our understanding of
how human beings learn and how to apply that knowledge to teaching. Dr. Benjamin
Bloom’s contribution (1956) has been to identify and describe cognitive processes. His
initial work outlined a hierarchical ordering of these processes. His taxonomy covers three
major domains: Cognitive, affective, and psychomotor. Learning at the highest level of
each domain is dependent on having achieved the prerequisite knowledge and skills
at the lower levels, so that each domain builds on the domains underneath it. What is
important for understanding the learning process is that there is a cognitive or mental
process that involves not only knowledge attainment but must include comprehension,
critical thinking skills, awareness and growth in attitudes, emotions, and feelings, and the
ability to physically manipulate tools and instruments. Furthermore, this process must be
reflective of the individual’s stage of development across the life span.
Another important theorist is Jerome Bruner whose work took place in the 1960s. His
learning theory has direct implications on teaching practices. Firstly that instruction must
be appropriate to the level of the learners. Second, material must be revisited often
using a variety of contexts and strategies to provide the students deeper comprehension
and longer retention. Third, the material should be presented in a sequence that gives
the learners the opportunity to acquire and construct knowledge and to transform and
transfer or apply new material. This is why it is important to encourage students to use
their prior experiences to understand and to be able to translate new materials. In this
process students need to be encouraged to see the similarities and differences between
the new and already acquired knowledge. And Bruner also stated that feedback should
be in the form of knowledge or information not only through grades and competition.
This process of going back and forth between new and old information and building an
increasingly complicated knowledge base is called spiraling.
The last theorist whose work we will mention here is David Ausuble. He also published his
work in the 1960s. His major contribution is the concept of advance organizers. An advance
organizer is provided by a teacher who shapes the organization of new information.
Advance organizers are just that, they prepare students for new material by highlighting
its relationship to prior knowledge. Put into the context of prior knowledge, new material
is made easier to learn particularly information that is more complex and sophisticated.

Motivation
Another factor that is a very important driver of learning is motivation. Motivation is
an internal state that impels people in a certain direction, which may be cognitive or
behavioral – and then is sustained. There are many factors that affect motivation, some of
which are internal whereas others are external. Extrinsic motivation occurs when the source

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 for motivation comes from outside the person and task. This could be the desire for or
expectation of rewards, which may be tangible (e.g., financial gain) or intangible (verbal
praise or desire for positive attention). Motivation can also result from a fear of punishment,
which again can be either tangible (e.g., a failing grade in a class or suspension) or
intangible (e.g., the desire to avoid negative attention or public embarrassment). Intrinsic
motivation occurs when the source of motivation comes from within the individual. The
individual may see a task as enjoyable or (at least) worthwhile, and then does it for its
own sake. Of course, motivation can be (and usually is) both intrinsically and extrinsically
motivated. But students who are intrinsically, rather than extrinsically, motivated are more
likely to: Begin a task on their own, pay attention, learn material in a meaningful way, show
creativity, be persistent despite failures enjoy learning-based activities, evaluate their own
progress, and achieve at high levels of performance.

Maslow’s Hierarchy of Needs

One of the major theorists who have influenced the fields of human development and
learning is Abraham Maslow. Maslow was also interested in human needs and his hierarchy
of needs parallels the other stages of development. He views development in terms of
need. Humans first require attention to physiological needs—food and warmth, then
safety, then love and belongingness, and then on to esteem and finally self-actualization.
These needs are associated with needs for competence and self-worth, for relatedness,
for affiliation, for approval, and finally for achievement. Implications of Maslow’s theory for
the school environment and prevention include the following: Students need to be aware
of what is expected of them and that they have set routines that they follow in a structured
environment. They need to feel that they are part of a group, and will tend to conform to
the dress, speech, and behavior of their peers. They also need to be respected by their
peers, which is likely to induce them to behave in a wide variety of ways, not all of them
constructive. Students also have a need for competence and self-worth. Competence
means that individuals feel that they can cope successfully with their environment. They
also need to establish and defend their self-worth. One way is by striving to succeed in
academic and social settings. But another is by avoiding failure. Students may do this in
a variety of ways. They may set low expectations for themselves, refusing to participate in
an activity or to complete an assignment by not trying, and thus risking failure. They may
cheat on tests, or avoid or procrastinate, by putting academic assignments off until the
last moment.
So how does Maslow’s Hierarchy of Needs translate into sound policies and procedures
in schools and classrooms? Here are some examples:
„ Allow students to take restroom breaks.
„ Allow students to drink water in the classroom.
„ Refer sick or troubled students to the nurse or counselor.
„ Change classroom activities frequently.
„ Encourage students to ask questions
„ Acknowledge students’ achievements.

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„ Have an orderly classroom.
„ Have students follow procedures for daily tasks.
„ Be consistent in dealing with students.
Adolescents also have a need for relatedness - to be connected socially to others. They feel
this leads to respect and self-worth. This need may be manifested in the following ways,
some positive and some not so positive. For example, they may prioritize socializing over
school work; try to look popular, smart, foolish, athletic, and sometimes try not to do well
academically, so they won’t stand out; or show concern for and help others. Adolescents’
need for affiliation is quite similar to “relatedness.” Need for affiliation describes children
who desire friendly relationships. Some children have a high need for affiliation, whereas
others have a low need. Children with a high need for affiliation might: Be nervous when
watched by others; communicate frequently, even compulsively, to stay connected; be
affected by peer pressure, which can be a major reason why children may initiate and
continue to use substances; be more interested in cultivating and sustaining relationships
than completing school-related tasks; and earn lower grades in school than their peers.
But these children can thrive in a classroom with a nurturing teacher.
Some children, particularly if they are insecure, may have a strong need or desire to look
good in front of others and in school for the teacher. In the latter situation, this might be
manifested in seeking the teacher’s recognition or approval, perhaps by being called on
frequently in class or other ways of “showing off.” Other children may be more interested
in seeking the recognition and approval of their peers. Many children have a strong
intrinsic desire to achieve excellence academically and socially. They may be persistent,
realistic about tasks, and set high standards. In school these may be learners who fall into
one of four groups, as follows: over-strivers, who work very hard and may obsess over
details and grades; optimists, who generally believe they will succeed; failure avoiders,
who will go out of their way to find situations in which they will not fail, often by taking the
easy way out; and failure accepters, who seem to have given up hope and have accepted
the likelihood that they will fail. They may say, or think, that they don’t care.

Developmental Periods
Middle Childhood
We now turn our attention to several developmental periods of childhood and adolescence
that are key to understanding how best to develop and present or implement prevention
interventions. The first developmental period we will address is Middle Childhood.
Generally this includes children around ages 6 through 11 years, and includes the
transition from home to school. Young children who are just entering school are making
an enormous life transition. They are leaving the protection and support of their family,
and have to make their way in a new environment with which they are largely unfamiliar
- their school. They need to develop trust in and form bonds with their school, develop
relationships with their teachers and peers, and learn what to expect (and what not to
expect) from their teachers. They must also learn a new set of roles and responsibilities
at school, which include listening to their teachers and following instructions. They need
to develop communication skills, which include when and how to speak – and when not

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 to – and how to listen for and follow their teachers’ instructions. Children must also learn
– and fairly quickly – to manage their impulses; that is, how to control and contain their
emotions, and how, when, and to whom to express their needs. From their first days at
school they are faced with complex problems to solve and decisions to be made, to which
they must respond appropriately. They learn by trial and error, but also by observing
the consequences of other children’s appropriate and inappropriate behaviors. Children
not only learn how to behave with one another, but they also have to acquire the skills
needed to share objects and skills, and work cooperatively with other children in teams
to accomplish a given set of objectives. Students also must learn to understand, respect,
and accept inter-personal differences relating to gender, race, ethnicity, culture, socio-
economic status, and physical appearance. And those are just children’s elementary
school years.
Children in the 6-11 age range are rapidly acquiring knowledge and skills. During this
period, routines, limits, and structure will help children feel secure during this time of
transition. Children are learning rapidly by both watching and interacting with their
parents, other adults, and other children. Parents and teachers can consciously model,
and expect respect and other forms of prosocial behaviors. During this developmentally
critical period, 6-11 year olds also learn social skills through play. Further, schools can
and should play a significant role in preventing violence, bullying, and teasing. Besides
learning academic material, children learn how to function successfully in society.

Early Adolescence
We now turn to the developmental period called early adolescence. Early adolescence
(aged 12-15) is a period of many challenges as the brain continues to develop in the context
of hormonal and other normal biological processes. The adolescent developmental
period is fraught with stress and erratic emotions that can lead to poor decision making
thus increasing the likelihood of engaging in risky behaviors that may have negative health
and social outcomes. In early adolescence, children begin to spend less time with their
family, and more time with their peers and peer groups, particularly in school settings.
These peer groups may constitute positive or negative influences, depending on whether
they are characterized by pro- or anti-social norms. Anti-social children, or those who
tend to be social isolates, may seek out others like themselves, which will increase the
likelihood that they will engage in risk behaviors.
The culture and environment of a school becomes even more important when children
begin the rapid changes that characterize adolescence, as a means to teach students a
variety of key life skills. These include decision-making and problem-solving, the ability
to regulate impulses and emotions, and shaping and rewarding positive behaviors – and
in sanctioning inappropriate behaviors. This is also a time when many children are first
invited by their peers to use substances, with the implied expectation that this shared
activity will constitute a relatively quick pathway to acceptance by a peer group. To
children with a history of social isolation or marginalization, and to those who have been
teased or bullied and have no peers to turn to for protection, an inducement to use
substances may be very difficult to refuse. Children in early adolescence should be able
to accept responsibility for their behavior and its consequences.

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They should also be able to develop and maintain friendships, and communicate
effectively with their teachers and peers. They should understand their own core values
and attitudes and, when making decisions, be able to anticipate whether their particular
behavior will reflect, or run contrary to, these values and attitudes. They should also be
able to understand the forms that peer invitations to behave in an anti-social manner may
take, and respond in an effective manner to these inducements.

Adolescence
The third developmental period that we will describe is adolescence. In most societies,
it is in later adolescence that youth aged 16-19 begin to take on adult roles, and may
become more independent of their families. They will be introduced to new belief
and value systems and new behaviors including the use of tobacco and alcohol and,
perhaps other substances. In later adolescence, they are actively seeking a greater level
independence, and increasingly believe that they are ready to fully assume adult roles
and responsibilities. Their bonds to their families of origin, and to their teachers, weaken
further and they are more likely to look to, and affiliate with, their peers. As these peer
groups become increasingly important, the norms the groups develop can become
very powerful guides to their behavior. Youth who have not learned how to make sound
decisions and control their impulses may increasingly demonstrate risk behaviors within
groups characterized by antisocial norms and expectations. During adolescence, children
are developing the capacity to think abstractly about complex constructs that may not
be related to their experience. They are acquiring the skills to think deductively – that is,
the process of top-down reasoning from one or more general statements, or premises,
to reach a logically certain conclusion. That is, if one thing is true, than another must be
also. Adolescents are also developing the skills to address and think through a variety of
complex problems – including social as well as academic – and to draw conclusions and
generalize from their particular set of personal experiences.
Adolescents’ brains are developing very rapidly at this stage, so that they can think critically
about situations and consider the consequences of various alternative behaviors. To
varying degrees they learn to control their impulses, recognizing that their initial response
may either not be in their best interest or those of others who are affected by what they
do. Not all of the changes that occur in adolescence, of course, are positive. During this
period youth often engage in strong and intense interests and passions that may not last
long and toss them about like a storm does a sailboat. Further, youth start preferring the
company of their peers to that of their parents and families, which can be a source of
conflict. Also at this time, adolescents prefer active to passive learning, which can be very
challenging to teachers whose preferred didactic style is to lecture. As you will see, all of
these changes are directly related to school-based drug prevention programming, and
help explain why some types of strategies are effective while others are not.
As we have seen, youth acquire successive levels of competence, and are challenged
by different sets of life skills, as they grow through childhood into adolescence. Their
developmental stage must be carefully considered when selecting prevention strategies,
to ensure that these strategies target them at an appropriate age. Fortunately, as we will
see, most evidence-based prevention programs specify the ages of populations on which
they have been tested and found to be effective.

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Participant Manual: Module 3—Child and Adolescent Development
 Revisiting the Etiology Model
In conclusion, let’s review the etiology model that was discussed in Course 1 and Module
2. The essential aspects of the model are the interactions between individuals and their
micro- and macro-level environments, which constitute the socialization process. The
model depicts the influences that shape how we perceive and respond to the environments
around us. That is how we learn language, how we learn to behave in specific situations,
and how to become acceptable, respected, and valued members of our families, our
communities, and our societies.
What makes up the individual’s personal characteristics (Sloboda, 2012) is key to the onset
of substance use. You have already heard about the importance of genetic predisposition
in the etiology of substance use. Other factors at the individual level include early and
continued exposure to alcohol use in the home. Young children with a challenging
temperament or a conduct disorder – often marked by poor impulse- and self-control –
are also likely to use substances when they get older, as are children who are rebellious,
aggressive, and otherwise anti-social in their behavior. Youth who seek new sensations and
experiences are also much more likely to try substances to experience their effects. These
characteristics represent vulnerabilities. It is the quality of the interaction between these
individual characteristics and the response of members of the micro-level environment
such as parents, teachers, and faith-based leaders that either protects individuals or puts
them at risk. In the family, poor parenting has been implicated in substance use. Parents
may be unresponsive to or detached from their children.
In school, for example, both school failure and low commitment to school (or low
school bonding) have been repeatedly linked to substance us. In the neighborhood or
community, the macro-level environment, two characteristics have been associated with
substance use: Community norms and values that support use, especially among children
and adolescents; and communities where alcohol and other drugs are readily available
and accessible.

School Prevention Objectives

As described above, effective substance use prevention strategies are designed to address
the different development stages of children (Ginsburg, 1982; UNODC International
Standards, 2013). For example, for children in middle childhood, substance use prevention
strategies should focus on the delivery of simple, straightforward instructions—e.g.,
doctors give you medicine when you are sick to make you well; medicine can be bad for
you if you take it without a doctor telling you to; giving medicine to others is dangerous,
even if they ask for it. In the early middle child years, teachers can implement strategies
designed to reward prosocial behavior and sanction impulsive or otherwise inappropriate
behaviors.
Early adolescents are sufficiently sophisticated to begin to understand with assistance
that they should develop positive values and attitudes that are contrary to substance use,
and on which they can base their decisions as to whether to use. Students can learn their
school’s policies concerning both legal and illegal substances, and the consequences of
infractions.

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Managers and Supervisors Course 05: School-based Prevention Interventions
For later adolescence, students should be able to use their values, decision-making skills,
and various life skills – particularly their assertiveness or “resistance” skills - in situations
where substances are being used or where they may be invited to use substances.
They should also learn society’s penalties for the use of substances that are unlawful for
adolescents and adults. Finally, they can be taught a variety of strategies to reduce the
adverse consequences of substance use (Marlatt, 2011). As we have seen, these may
stress the dangers of drinking and driving, or riding with a driver who has been drinking.
Clearly evidence-based prevention interventions must be carefully matched to the
developmental stage of the children to be effective. Prevention science is thus built on
child development and how best to reach children at each stage of development.

References
Bloom, B.S.; Engelhart, M. D.; Furst, E. J.; Hill, W. H.; Krathwohl, D.R. (1956). Taxonomy
of educational objectives: The classification of educational goals. Handbook I: Cognitive
domain. New York: David McKay Company.
Ginsburg, I. (1982). Jean Piaget and Rudolf Steiner: Stages of child development and
implications for pedagogy. The Teachers College Record, 84(2), 327-337.
Marlatt, G.A. et al., eds. (2011). Harm reduction: Pragmatic strategies for managing high-
risk behaviors. Guilford Press.
Renner, J., Stafford, D., Lawson, A., McKinnon, J., Friot, E., & Kellogg, D. (1976). Research,
teaching, and learning with the Piaget model. Norman, OK: University of Oklahoma Press.
Sloboda, Z. et al. (2012). Revisiting the concepts of risk and protective factors for
understanding the etiology and development of substance use and substance use
disorders: Implications for prevention. Substance use & misuse, 47(8-9), 944-962.
United Nations Office on Drugs and Crime. (2013). International Standard on Drug Use
Prevention. Vienna, Austria: UNODC. Available at: http://www.unodc.org/unodc/en/
prevention/prevention-standards.html

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Participant Manual: Module 3—Child and Adolescent Development
136
Managers and Supervisors Course 05: School-based Prevention Interventions
 MODULE 4
DEFINING THE SUBSTANCE USE PROBLEM FOR
PREVENTION PLANNING IN SCHOOLS

Content and timeline .....................................................................................138

Training goals and learning objectives .........................................................138
Introduction to module 4 ...............................................................................139
PowerPoint slides ...........................................................................................140
Summary..........................................................................................................176

Participant Manual: Module 4—Defining the Substance Use Problem for Prevention 137
Planning in Schools
 Content and Timeline
Person
Activity Time
Responsible
Introduction to Module 4 15 minutes
Presentation: Substance use by children and
15 minutes
adolescents
Large-group discussion: Youth substance use in my
30 minutes
community
Presentation: Progression of substance use 15 minutes
Presentation and discussion: Student substance use
20 minutes
data for prevention programming
Presentation and discussion: Conducting/analyzing
30 minutes
student surveys on substance use
Break 15 minutes
Large-group discussion: Analyzing the findings 30 minutes
Presentation: Initiation and deterrence factors for
10 minutes
prevention programming
Small-group exercise: Student substance use
30 minutes
information
Presentation: Initiation and deterrence factors for
30 minutes
prevention programming (continued)
Summary and reflections 15 minutes
Module 4 evaluation 15 minutes
Lunch 60 minutes
Total Time = 330 minutes (5 1/2 hours)

Module 4 Objectives
Learning objectives
Participants who complete Module 4 will be able to:
„ Specify the substances that children and adolescents use, and the progression of use;
and
„ Describe a process to secure and analyze data about substance use in a particular
school or region.

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Managers and Supervisors Course 05: School-based Prevention Interventions
Introduction to Module 4
Module 4 will introduce you to the sources and types of data you can use to describe
the nature and extent of substance use in your community, as well as the factors involved
in the initiation and deterrence of substance use for prevention planning. The module
focuses on the drugs that are generally used when children and youth begin their
involvement with substance use. These include the substances most available to them,
such as, household products that are inhaled; prescription and over-the-counter (OTC)
medications; and the legal substances of alcohol and tobacco, which are usually illegal
for children. The module will examine so-called “gateway drugs” that for some children
and adolescents can lead to dependence and addiction.
Module 4 will also describe some of the research about the continuation and non-
continuation of substance use--known as the progression of substance use from initiation
to problem use. While there is limited research on this, one important finding for prevention
is that the earlier the age a child gets involved with substances, the more serious the
potential for abuse and dependence. So, a key objective for prevention programming is
to prevent and delay initiation of substance use for as long as possible.
Data on student substance use includes quantitative archival data, such as student records,
or survey data available from other sources or conducted locally. Qualitative data from
focus groups or key informants can expand upon survey information by providing more
descriptive information about the substance use situation that can help “build the case
for prevention” and develop specific prevention approaches to address the problem.
The module will also describe the advantages and disadvantages of using existing data
versus conducting your own survey.
Lastly, the module will describe the types of student survey measures and questions
available on some of the factors that influence the initiation and deterrence of substance
use, such as, beliefs, attitudes, norms and self-efficacy. These are important measures
that can help evaluate the impact of prevention interventions, which target these factors.

Participant Manual: Module 4—Defining the Substance Use Problem for Prevention 139
Planning in Schools
 The Colombo Plan Drug Advisory Programme (DAP) Training Series
Universal Prevention Curriculum for Substance Use (UPC) Managers and Supervisors Series

Managers and Supervisors

Course 05
School-Based Prevention
Interventions

MODULE 4—DEFINING THE SUBSTANCE

USE PROBLEM FOR PREVENTION
PLANNING IN SCHOOLS



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Managers and Supervisors Course 05: School-based Prevention Interventions
 Learning Objectives

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Participant Manual: Module 4—Defining the Substance Use Problem for Prevention 145
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Participant Manual: Module 4—Defining the Substance Use Problem for Prevention 159
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Participant Manual: Module 4—Defining the Substance Use Problem for Prevention 161
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 Initiation and Deterrence
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Participant Manual: Module 4—Defining the Substance Use Problem for Prevention 163
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Planning in Schools
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Participant Manual: Module 4—Defining the Substance Use Problem for Prevention 169
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 Normative Beliefs



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Participant Manual: Module 4—Defining the Substance Use Problem for Prevention 173
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 Summary

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 Module 4 Evaluation
15 minutes


Participant Manual: Module 4—Defining the Substance Use Problem for Prevention 175
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 Summary of Module 4: Defining the Substance Use
Problem for Prevention Planning in Schools
Substance Use by Children and Adolescents
Children and adolescents use different substances at different ages, and some researchers
(but not all) believe that there is a natural progression from the use of one substance
to another. There are also differences in the substances which are used by children
and adolescents in one community or geographic area from another. This module was
designed to help you gather data on the nature and type of substances that school
children are using in your country or region. This evidence can help to persuade your
schools and communities of the importance of allocating time and resources to substance
use prevention interventions and to pick the interventions that are most appropriate for
your schools.

Misuse of Household Products

There are many types of substances that children and youth misuse for their psychoactive
(that is, mind-altering) qualities. One set of substances that many people do not think
about, because they are readily available in most children’s homes, are harmful household
products (NIDA, 2012, 2013, 2014). Many children begin substance use by inhaling, or
“huffing,” chemical vapors from household products that can be found under the kitchen
sink or in a cabinet. These include spray paints, markers, glues, and cleaning fluids. Huffing
causes a brief feeling of euphoria as the chemicals inhaled reduce the flow of oxygen to
the brain. Huffing these products is very dangerous, particularly for children’s developing
brains. Huffing can also affect the central nervous system and damage kidney, lung and
liver function. In the United States, one teenager in five has used inhalants to get high.

Misuse of Prescribed and Over-the-Counter (OTC) Medications

Other substances that are readily available in many bathroom cabinets are prescribed
medications, and particularly controlled substances, such as opioid pain relievers like
Oxycontin, stimulants like Adderall, and central nervous system depressants like Xanax.
These are fueling a growing epidemic in the United States. But children can also use
some over-the-counter (OTC) medications. These medications can directly damage the
developing brain. Some of them are addictive; others increase users’ risk for a variety of
other health effects, including overdose, especially when combined with alcohol or other
drugs. Among the prescription and OTC medications are: Stimulants, which can raise
body temperature and cause irregular heartbeats, and their repeated use, can lead to
expressions of paranoia;opioids produce drowsiness and can depress breathing, leading
to overdose. Opioids are now beginning to be considered a “gateway” drug to heroin
use. Central nervous system depressants can also produce drowsiness, slow down brain
activities, and lead to withdrawal symptoms. All these drugs adversely affect people’s
judgment and decision-making, and may lead to addiction.

Alcohol and Tobacco Use

Other substances, which in most countries are legal for adults but not for minors, are
alcohol and tobacco. These have traditionally been considered “gateway” substances

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Managers and Supervisors Course 05: School-based Prevention Interventions
to other, potentially more destructive substances – like opioid pain relievers or heroin.
For example, we know that the use of tobacco and alcohol generally precedes the use of
marijuana, which in turn precedes the use of cocaine. That is not to say, of course, that all
children who use alcohol and tobacco will proceed down this path – fortunately, most don’t.
As you know from the initial course in this series, alcohol and tobacco (that is, nicotine) are
also damaging to children and adolescents (Hiller-Sturnhofel and Swartzwelder. You have
already heard that the adolescent brain is particularly susceptible to some of the effects
of alcohol, which have adverse effects on one’s ability to form new and lasting memories,
motor coordination and balance, and decision-making. Furthermore, frequent high levels
of alcohol consumption – that is, binge drinking – may result in lasting cognitive deficits
that are likely to affect academic performance.
A number of studies have demonstrated that adolescent brains are also responsive to
the rewarding properties of nicotine, the active ingredient of cigarettes, thus enhancing
the risk for addiction. In addition, adolescents react less to high levels of nicotine than do
adults, and may thus smoke tobacco products more to achieve the same effects (Dwyer, et
al., 2009). They are also more susceptible than adults to the effects of nicotine as a means
to reduce anxiety. Nicotine affects the brain’s prefrontal cortex, which is responsible for
“executive” functions such as impulse control and making rational decisions. It can also
damage the lungs and lead to a wide variety of later health problems, including cancer.
The harmful effects of nicotine on any later cocaine use can be substantial (Huang, et
al. 2013; Volkow, 2011). For example, during adolescence the childhood and adolescent
brain goes through a period of rapid growth, partly in response to new experiences.
During that time the growth in the connection among neurons, or nerve cells, is affected
by which groups of neurons are regularly stimulated. This process is called “plasticity.”
New scientific evidence suggests that the metaplastic effect of nicotine on the brain’s
striatum, which is involved in complex automatic behaviors like driving a car, and on the
amygdala, which is involved in emotional response.
There are other substances that are only available illegally which may be particularly
dangerous, because users do not know what combination of drugs they have been given
(or have purchased). The point to be made here is that there is a wide array of substances
of abuse that are potentially available to children, and the number of these is constantly
increasing. The latest, in the U.S. are e-cigarettes, which function as an efficient delivery
mechanism for nicotine, and are marketed as a “safe” alternative to cigarettes, although
there is preliminary evidence that they too may damage the lungs Medical News Today
(2012).

Progression of Substance Use

Now, what do we know about the progression of the use of various substances from
childhood to adolescence to young adulthood? We noted earlier that in most countries
the age at which young people begin to use the substances of interest to us is in middle
to late childhood and adolescence (Degenhardt, et al. 2008; Lynskey, et al. 2003). They
may start by using harmful household products, or alcohol, or tobacco, depending on
what they can easily secure from their homes or their friends. Decades of research have
shown that the earlier children initiate use, the more likely they are to use later in life

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 and become problem users. A major goal of school-based substance use prevention
programs is to postpone initial use of any psychoactive substance as long as possible.

Non-continuation of Substance Use

Many children and youth, however, who begin to use early do not later become problem
users. Although there is sparse evidence available regarding why some adolescents stop
using psychoactive substances once they have started, there is indication from results
of population surveys that a substantial proportion of substance users do stop using.
Estimated rates of non-continuation show variations by age and drug class. For instance,
data from the 2012 U.S. survey Monitoring the Future indicate that non-continuation rates
for 17-18 year old students range from 48 percent for the use of ecstasy, to 20 percent
for use of marijuana and cigarettes, to 9 percent for alcohol (Johnston et al. 2013). There
are other instances of non-continuation or natural recovery from substance use without
treatment among adults. Most available studies of natural recovery focus on alcohol
(Smart, 2007); fewer include other substances. Although both surveys and special studies
within community populations identify people who cease using drugs without treatment,
the duration of being drug free and the reasons or factors associated with cessation are
not consistent (Sobell et al., 2000).

Continuation of Substance Use

It is important to note that no single factor determines whether a person will continue to use
psychoactive substances and become addicted. Research shows that it is the interaction
of a variety of both biological and environmental factors that increases adolescents’ risk
of becoming a regular substance user and to progress from regular use to abuse and
addiction. Biological factors include genetics as well as temperament, for instance. It
has been estimated that between 40% and 60% of a person’s vulnerability to addiction is
due to genetics and other biological factors. However, as we noted in the earlier module,
genes by themselves are not sufficient for someone who uses substances to become
a substance abuser. Clearly a number of other factors are involved including parenting
styles and family functioning, accessibility to substances, academic achievement, and
peer and community influences. We do know that if children’s substance use continues
into adolescence, they are less likely to use harmful household products, which usually
taper off by the time children reach the age of 14 or 15. They are more likely, however, to
escalate their use of tobacco and alcohol, and to begin to use other substances that are
illegal for adults, like marijuana.

Student Substance Use Data for Prevention Programming

Student substance use data is helpful to understand the extent of substance use and
the nature of use, that is, what types of psychoactive substances are being used. Earlier
curricula in the UPC series have talked about conducting needs assessments which
involve collecting and/or analyzing existing data to describe the substance use problem.
So, needs assessments to describe student substance use include data on: The types
of substances being used, the frequency of their use, and the mode of administration;
sources of substances being used; characteristics of those using substances, including
gender, age, ethnicity, residence, absenteeism from school, and physical and emotional
health; and the age of first use and the first substance used.

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Quantitative and Qualitative Data
The different types of data that are available on substance use include both quantitative
data that provides information that can be counted and qualitative data that is more
descriptive in nature. Quantitative data can be found in existing records or archives or
collected directly from the population of interest through surveys or questionnaires. Good
sources of qualitative data are from focus groups that can be composed of members of
the target population or those that would know about substance use in this population
or through key informants, such as school administrators and staff, parents, and, law
enforcement. The combination of quantitative and qualitative data will provide the best
overall picture of student substance use and its associated social, health and mental
health problems.

Quantitative: Archival Data

Archival data generally represent the consequences of, or problems associated with,
substance use that come to the attention of key organizations such as the school, law
enforcement, and health service agencies.
School-based data. Types of archival data that may be accessed directly from the school
administration could include records on disciplinary actions related to infractions of
school substance use policies. These may include suspensions or expulsions, referrals for
health or mental health assessments that may be substance use-related, and absenteeism
and truancy, again that may be substance use-related. Another source of information on
student substance use may be found in arrest records, particularly adolescent arrests for
substance use and substance use-related incidents, such as drunk driving, and the selling,
possession, or consumption of substances that are illegal for children and adolescents.
Hospital and health records. Hospitals also can provide information on health and
mental health problems that are substance use-related. These would include emergency
department episodes for opioid overdose, alcohol poisoning, and vehicle crashes or
more psychological problems such as hallucinations and depression. In addition, hospital
admissions for these types of physical and mental health problems are also available. In
addition, there are substance use-related deaths that may come to the attention of local
coroners or medical examiners. Further, many local health departments keep records of
deaths with the conditions noted that contributed to the deaths. Finally, substance use
treatment programs will have admission records that may provide information on children
and adolescents who are admitted to treatment facilities. Finally, there may be existing
survey data completed by a government agency such as the health department or schools
or by a university that may include information on substance use among children and
adolescents.
Biases in the data. However, all of these archival data are subject to biases: that is, problems
that may affect your ability to use them, with confidence, as indicators of substance abuse
problems in your community. Some of these problems may relate to the quality of the
data, that is, how well the data reflect what really happened. Other problems may relate
to how well the data, even if collected consistently and comprehensively over time, are
meaningful: that is, they truly indicate the nature and extent of the substance use problem.
For example, hospital records concerning admissions attributable to substance use may

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 vary considerably in quality depending on a variety of factors, including how conscientious
medical care providers are in recording substance use, which may be stigmatized, as a
primary or secondary cause of the admission. There may be errors in coding these data,
especially if they are presented as text (or written narrative) instead of items or codes on a
checklist. If you were using these data to investigate trends over a multi-year period, you
would want to make sure that data recording and collection procedures were reasonably
stable over time. By the same token, hospital records of adolescents who are admitted for
alcohol-related causes may be relatively meaningless if you can’t determine, for example,
whether the children admitted were from the community or region you are interested in,
or someplace else. Or the hospital may cost too much for parents of children experiencing
alcohol-related problems to afford and therefore parents won’t take their children there
for care. Or perhaps adolescent alcohol abuse is heavily stigmatized in your community,
so parents are likely to seek help for their children elsewhere.

Quantitative: Student Substance Use Surveys

Other sources of quantitative data relating to student substance use are surveys that ask
students directly to report about their substance use and related questions. These surveys
can be completed with students at school. In general, these surveys are self-administered,
which means that the students are given the survey forms or questionnaires and then
fill them out themselves under the watchful eye of a trained data collector. Surveys or
questionnaires can also be completed at home. These can be completed by a trained
survey administrator who asks questions and fills out the responses on a questionnaire
form. Or they can be completed by the student by answering questions either directly on
the paper questionnaire form or on a computer, under the supervision of a trained survey
administrator.
Advantages and disadvantages of different approaches. As with most research efforts,
there are both advantages and disadvantages with each of these approaches. The school
survey has more advantages over the household survey as students are more ‘truthful’
when they are not located close to parents or other family members whom the students
may fear will look at their answers. Household surveys are also more ‘work’ intensive and
therefore much more expensive than school surveys.
Another caution is when the survey was conducted. How ‘old’ is the information?
Substance use patterns do change over time—new substances become available, as do
new methods for using them, and the ‘popularity’ of a substance varies over time. These
issues all affect the usefulness of older survey data. Finally, what was the population base
for the survey? Did it include children and adolescents within the community of interest?
How comparable are the characteristics of the students who completed the survey to
those who live in your community? What special or vulnerable populations of young
people in your community may not have completed the survey?

Qualitative: Focus Groups/Key Informants

Focus groups and key informants are other sources of qualitative data. Focus groups, like
surveys, can also provide information on substance use among students. These groups
can be made up of groups such as students or school officials, law enforcement, health
department, or substance use treatment staff. And key informant interviews can provide

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descriptions of substance use among students from the perspective of the informants’
own observations. Selecting the ‘right’ individuals to be included in the focus groups or
as key informants may be a challenge. In addition, special attention must be given to the
size and composition of the focus groups.

Conducting/Analyzing Student Surveys on Substance Use

As important as these other methods are for providing key information of substance use by
students and other groups, student surveys conducted in the school setting are generally
considered to be the best overall method for collecting data on student substance use.
These data form the core of data collection efforts that may include the other types of
qualitative and quantitative data we just discussed. Although conducting surveys with
students is relatively inexpensive and provides the best information on current patterns of
substance use and on related perceptions, these surveys can be challenging to develop,
administer, and score, and the data may be difficult to analyze and interpret. However,
if students truly believe that their responses will be kept confidential, they are likely to
provide reliable and valid answers.
Using standardized questions that may be drawn from student surveys conducted in other
areas of the country or region is also useful as it allows comparisons with these other
groups. Furthermore, conducting school surveys annually over multiple years provides
data that can be compared across time. This is particularly important when prevention
interventions are introduced into the schools, especially when surveys are administered
both prior to the introduction of the intervention and then again following its completion.

WHO Global Student Survey

Schools also may choose to use the results of surveys that have been conducted by other
organizations. In this regard, we particularly recommend surveys sponsored by the UN,
which has published a very helpful manual (UNODC, 2003). The World Health Organization
(WHO) sponsors an international student survey that is conducted periodically in many
countries. Even though some of these surveys (and thus their results) may be dated, they
still can provide useful benchmarks against which to compare the results of a locally-
conducted survey. They can also be used, with great care, as a proxy for a school’s own
survey, particularly if the findings are disaggregated by region or (perhaps) population
density (i.e., urban vs. suburban vs. rural). However, local data are almost always more
believable to local policy makers and decision makers than data from regional or national
surveys. It is very easy for people to discount troubling results of a substance use survey
conducted in a country or region by saying it does not represent the children in “our”
community.
Student and household surveys have been considered the mainstay of any substance use
data collection effort for over 40 years. These surveys provide information on how extensive
substance use is in a population and, of particular interest to Prevention Practitioners, on the
age of initiation of use among children and adolescents. Many countries across the globe
collect data on substance use among their student populations. As a result, international
organizations such as the WHO have become the repository for this information. Much
of the data presented in the UPC curricula come from these reports. Other international

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 groups such as the European School Project on Alcohol and Other Drugs (ESPAD: http://
www.Espad.org/ ) and national groups such as the United States (Monitoring the Future:
http://www.Monitoringthefuture.org /) have developed and conducted student surveys.
The Monitoring the Future student survey has been administered annually since 1975. The
survey collects information on high school seniors aged 17-18 attending a representative
sample of public and private high schools. In 1991 the survey added samples of students
in the 8th and 10th grades, aged 13-14 and 15-16.

How Student Surveys Are Conducted

This module presents the different ways to measure substance use through student
surveys using the WHO Global School-Based Student Health Survey as an example. The
purpose of the WHO survey is to provide data concerning a range of student behaviors
related to health to help countries set priorities. The survey identifies which health issues
are most salient and thus should be targeted for interventions, and provides data that
can be used to advocate for health-related policies and programs. Survey results can
also be compared across countries and, in many cases, across regions within countries.
The school-based survey is designed for children aged 13-17, and thus includes both
middle and high schools. Survey results are based on representative, random samples.
This means that the sample of schools selected is representative of all the schools in the
country, and that the sample of students selected in each school is representative of all
the students in that grade range. Survey results typically report point estimates, which are
usually expressed something like this: “30% of the students in the sample report that they
have used tobacco in the past 30 days.”
The surveys are self-administered. This means that the forms are handed out to the students
by a trained staff member and that the students answer the questions individually by
themselves. The setup for self-administered surveys is to separate the students from one
another so that they cannot see each others’ responses, by having them sit at alternative
desks. And, of course, these surveys include questions on alcohol, tobacco, and drug
use, which is what makes them so potentially useful– both in terms of documenting the
nature and extent of substance use, and as a source for questions that can be used on
locally developed surveys. In general, all survey questions are ‘close-ended’ meaning
that the students must select the most appropriate answer from amongst several
possible responses. “Open-ended” questions generally requests that the respondents
to the survey write in their responses. Using “open-ended” questions adds an additional
expense to the data collection effort that can be very high. We know from earlier curricula
that the maintenance of ethical standards is important for any data collection effort. For
those under the legal age of majority—sometimes 16-18 years of age—parental consent
is often required.

Initiation and Deterrence Factors for Prevention Programming

The types and content of information needed for prevention programming of student-
aged populations includes the nature and extent of student substance use. But also
important to prevention is knowing the factors that influence the initiation or deterrence
of substance use that can be examined and addressed in prevention programs. Here
are some of the factors that affect the initiation or deterrence of substance use. These
include:
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Managers and Supervisors Course 05: School-based Prevention Interventions
„ Beliefs concerning the physical or psychological harm associated with substance use,
as well as positive expectations that substances may be relaxing, increase popularity,
or simply feel good;
„ Attitudes towards substances: That they are good or bad, healthy or unhealthy;
„ Norms concerning the extent to which same-aged peers used drugs, and perceptions
of social approval or disapproval of substance use by parents and friends; and
„ Perceived ability (self efficacy) to effectively refuse an offer to use a substance
without offending the person offering the substance.
As was the case with collecting information on the nature and extent of substance use
among children and adolescents, information on factors that are related to student
substance use can be quantitative or qualitative. While the sources may be comparable,
the best source that will shed light on these factors is likely to be student surveys. Care
should be taken in using older or existing surveys. Much depends on whether this
information was collected at all. Other things to consider are the degree to which the
characteristics of the survey respondents match your population of interest. Of further
concern is whether the questions about attitudes, normative beliefs, and perceptions of
harm were asked in general terms – in relation to multiple substances - or in reference to
specific ones. Remember that answers to these questions can differ substantially across
substances (for example, cigarettes relative to marijuana). Finally, focus groups and key
informant interviews of children and adolescents are particularly useful as a guide to
framing the questions that would be included on an ongoing survey or to help interpret
existing information. Remember that a combination of quantitative and qualitative data
will provide the best overall picture of student substance use and its associated social,
health and mental health problems.

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Dwyer, J.B., McQuown, S.C., & Leslie, F.M. (2009). The Dynamic Effects of Nicotine on the
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translational medicine, 3(107), 107ps43-107ps43.

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Managers and Supervisors Course 05: School-based Prevention Interventions
World Health Organization. (2008) Global School-Based Student Health Survey, Chile,
2013. Available at: http://www.who.int/chp/gshs/2013_Chile_GSHS_fact_sheet.pdf?ua=1.
World Health Organization. (2008) Global School-Based Student Health Survey, Thailand,
2008. Available at: http://www.who.int/chp/gshs/GSHS_FINAL_Report_Thailand_2008.
pdf.
World Health Organization. Global School-Based Student Health Survey (GSHS): Fact
Sheets. Available at: www.who.int/chp/gshs/factsheets/.

Participant Manual: Module 4—Defining the Substance Use Problem for Prevention 185
Planning in Schools
186
Managers and Supervisors Course 05: School-based Prevention Interventions
 MODULE 5
APPLYING THEORY TO SCHOOL-BASED
SUBSTANCE USE PREVENTION

Content and timeline .....................................................................................188

Training goals and learning objectives .........................................................188
Introduction to module 5 ...............................................................................189
PowerPoint slides ...........................................................................................190
Resource page ................................................................................................231
Summary..........................................................................................................233

Participant Manual: Module 5—Applying Theory to School-Based Substance Use 187

Prevention
 Content and Timeline
Person
Activity Time
Responsible
Introduction to Module 5 15 minutes
Presentation and discussion: Behavioral theories and
30 minutes
prevention
Break 15 minutes
Small-group exercise: Applying Theory of Planned
50 minutes
Behavior integrative model to interventions
Presentation: Applying the TPB integrated model to
10 minutes
school-based prevention
Presentation: Introduction to key principles of school-
15 minutes
based prevention interventions
Presentation: Developmental stages and learning:
35 minutes
middle childhood
Presentation: Developmental stages and learning:
35 minutes
early adolescence
Wrap-up 10 minutes
End of Day 3
Presentation and discussion: The basics of school-
30 minutes
based prevention interventions
Presentation: What doesn’t work in prevention 15 minutes
Small-group exercise: What works and doesn’t work 45 minutes
Reflections 10 minutes
Module 5 evaluation 15 minutes
Break 15 minutes
Total Time = 345 minutes (5 hours 45 minutes)

Module 5 Objectives
Learning objectives
Participants who complete Module 5 will be able to:
„ Explain an overarching theory of five key determinants of human behavior, explain
how the parts fit together, and apply the theory to substance use;
„ Specify five school-based prevention strategies that work, and five that have no
evidence of effectiveness; and
„ Discuss the importance of, and challenges related to, interactive teaching strategies.

188
Managers and Supervisors Course 05: School-based Prevention Interventions
Introduction to Module 5
Module 5 provides an overview of key theories of health-related behavior and their
application to substance use prevention programs for children and adolescents in the
school setting. It also addresses the standards, principles, and strategies related to
effective prevention, which take into account the learning processes that are related to
age.
The definition of theory in the behavioral sciences is a tool designed to predict human
behavior from a certain set of potentially measurable factors related to individuals or
groups and their social and physical environments. Useful theories also suggest points
at which efforts to change behavior may be successful. Theories can help address in a
systematic fashion the question of how students make decisions about behavior that
affect their health. So, theories provide a guide as to how to support positive decisions
and how to change negative ones. This presumes that people—in this case, adolescents-
-make decisions on the basis of a rational process of weighing pros and cons of decisions.
The module will direct particular attention to the Theory of Planned Behavior: Integrated
Model (TPB), which does as it suggests integrate most of the behavioral theories that
result from research; and the elements of which most often applied to school-based
interventions. You will learn about the primary elements of the TPB modelwhich contribute
to behavior:

„ Behavioral beliefs „ Intentions

„ Normative beliefs „ Environmental constraints
„ Efficacy beliefs „ Skills
„ Attitudes
Module 5 will also overview the key principles of school-based interventions. The
interventions are: Classroom curricula; school policy; and school climate. Most of
the research in the prevention field focuses on classroom curricula which have shown
significant effectiveness in preventing substance use and problem behavior in children
and adolescents. You will also hear about school policies, especially in regard to alcohol
and cigarette use, which have been effective if reasonably enforced; and school climate
which focused on young children and classroom behavior which had long-term positive
outcomes. These effective interventions recognize the importance of targeting the
developmental differences among children and adolescence and the kinds of learning
and social competencies of each age group.
The module will also explain the basic components of interventions: The content, structure
and delivery, and how each contribute to effective outcomes. Especially important to
school-based interventions is the need for interactive teaching as the principal delivery
approach. The module will end with a summary of What Doesn’t Work in Prevention.

Participant Manual: Module 5—Applying Theory to School-Based Substance Use 189

Prevention
 The Colombo Plan Drug Advisory Programme (DAP) Training Series
Universal Prevention Curriculum for Substance Use (UPC) Managers and Supervisors Series

Managers and Supervisors

Course 05
School-Based Prevention
Interventions

MODULE 5—APPLYING THEORY TO

SCHOOL-BASED SUBSTANCE USE
PREVENTION



Introduction



190
Managers and Supervisors Course 05: School-based Prevention Interventions
 Learning Objectives

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Participant Manual: Module 5—Applying Theory to School-Based Substance Use 191

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194
Managers and Supervisors Course 05: School-based Prevention Interventions
 Theory of Planned Behavior (TPB):
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Participant Manual: Module 5—Applying Theory to School-Based Substance Use 195

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 Theory of Planned Behavior (TPB):
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TPB Integrative Model: Attitudes



196
Managers and Supervisors Course 05: School-based Prevention Interventions
 TPB Integrative Model: Norms



Participant Manual: Module 5—Applying Theory to School-Based Substance Use 197

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 TPB Integrative Model: Self-Efficacy



TPB Integrative Model: Skills



198
Managers and Supervisors Course 05: School-based Prevention Interventions
 TPB Integrative Model: Environmental
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Participant Manual: Module 5—Applying Theory to School-Based Substance Use 199

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200
Managers and Supervisors Course 05: School-based Prevention Interventions
 Alcohol Use

9th Grade
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Participant Manual: Module 5—Applying Theory to School-Based Substance Use 201

Prevention
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Communication
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Skills



202
Managers and Supervisors Course 05: School-based Prevention Interventions
 Key Principles of
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Participant Manual: Module 5—Applying Theory to School-Based Substance Use 203

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Participant Manual: Module 5—Applying Theory to School-Based Substance Use 211

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Managers and Supervisors Course 05: School-based Prevention Interventions
Resource Page 5.1: Theory of Planned Behavior: Integrated
Model

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 Resource Page 5.2: What Works/Doesn’t Work in Prevention

What Works What Doesn’t Work

DELIVERY & STRUCTURE
Interactive methods Didactic methods such as lecturing
Highly structured lessons and group work Unstructured, spontaneous discussions
Follows a curriculum Reliance on teachers’ judgment and
intuition
Delivered by a trained facilitator/teacher Evidence for using peer-led vs. adult-led
prevention programming is weak
Implemented via 10-15 weekly sessions Any stand-alone, single event activities
Multi-component programs Evidence for the value of “booster”
sessions in successive years is weak
Posters and pamphlets
CONTENT
Decision-making, communication and Increasing students’ knowledge by
problem-solving skills providing facts concerning specific
substances—can simply make students
more informed consumers
Peer relationships and personal and social Ex-drug users providing testimonials can
skills end up glamorizing or sensationalizing
drug use
Self-efficacy and assertiveness Focusing on building self-esteem only
Drug resistance skills and strengthening Random drug testing
personal commitments against drug abuse
Reinforcement of antidrug attitudes and Scare tactics and frightening stories that
norms exaggerate and misrepresent the dangers
of substance use and often contradict
students’ own experiences and those of
their peers
Support for study habits and academic
achievement

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Managers and Supervisors Course 05: School-based Prevention Interventions
Summary of Module 5: Applying Theory to Substance
Use Prevention
Behavioral Theories and Prevention
Module 5 provides an overview of key theories of health-related behavior and their
application to substance use prevention interventions for children and adolescents in
the school setting. It also addresses the standards, principles, and strategies related to
effective prevention, which take into account the learning processes that are related to
age. It recognizes the fact that children learn differently from the way that adolescents
learn. It is important for children to experience effective learning, which implies that
children need to be actively involved in the learning process and that they can and should
control their own learning. Cognitive theory says that learning is an internal process and is
driven by organizing and connecting or linking knowledge. When given new knowledge,
humans first relate it to previously learned information. Thus one piece of knowledge or
information builds on another.
Changing behavior, particularly behaviors that are associated with health outcomes, has
received a great deal of attention since the 1940s. These theories have been effectively
incorporated into substance use prevention programs since the late 1970s (Evans, 1976;
Evans et al., 1978; Botvin and Griffin, 2003). In the behavioral sciences, which include
public health, a theory is a tool designed to predict human behavior from a certain set of
potentially measurable factors related to individuals or groups and their social and physical
environments. Useful theories also suggest points at which efforts to change behavior may
be successful. If they are particularly useful, theories may even suggest which of those
opportunities for interventions are most likely to change behavior. Most theories in the
behavioral sciences are borrowed from the field of social psychology, which is the study
of how people’s thoughts, feelings, and behaviors are influenced by others. The particular
utility of theories in regard to school-based substance use prevention interventions is that
they address, in a systematic fashion, the question of how students make decisions about
behaviors that affect their health, and provide a guide, or roadmap, as to how to support
positive decisions and how to change bad ones. That said, these theories also tend to be
somewhat simplistic in a variety of ways. One of these is that they assume that people in
general (and, in our case, children and adolescents in particular) make decisions on the
basis of a process that involves carefully weighing the consequences of their behaviors
– both the pros and the cons – and then coming to a rational decision as to what to do.

Theory of Planned Behavior (TPB): Integrated Model

A figure representing the Theory of Planned Behavior (TPB): Integrated Model (Glanz et
al. 2008) appears on Slide 5.7 and Resource Page 5.1 was briefly introduced in the previous
module. This integrative model looks like many other models in the behavioral sciences,
since it incorporates elements of many of them. Generally speaking, these models are
read from left to right; Behavior is at the right end. At the extreme left side are boxes
that are furthest away, or most “distal,” from behavior; those closest to behavior are the
most “proximal.” When you see a string of boxes connected by arrows that means that
the effects of the box to the left of the box to the right are “mediated,” or work through,

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 the box (or boxes) in the middle. Here is a simple example of mediation: The effects of
a loud noise like a firecracker on the brain is mediated by how well a person hears; that
is, someone who hears very well will react differently than someone else who is hearing
impaired.
Note that on the top far left of the figure, in blue, are Behavioral Beliefs about the
consequences of the behavior and the individual’s assessment of these consequences,
as driven by the individual’s values; middle far left, again in blue, Normative Beliefs
about what others think the individual should do and the individual’s Motivation to
Comply with what they think; and, at the bottom far left and also in blue, Efficacy Beliefs
or understanding that the individual has about the ability to perform a behavior or not
perform it. These beliefs serve to modify the person’s Attitudes, normative beliefs, and
assessment of his/her ability to perform a behavior – all in orange. Intentions concern
whether the individual plans on performing the behavior. Environmental Constraints,
in grey, indicate micro- and macro-level influences that impede the performance of a
behavior such as a law or regulation that limits the age for purchase of alcohol. Skills,
also in grey, are related to actually having the necessary skills to perform the behavior.
Skills and self-efficacy are related, but by no means the same. As an example, consider
people who begin using addictive drugs believing that they have the self-efficacy to stop
whenever they want – but then find that they lack the skills to do so. Or adolescents who
believe they can “just say no” to offers to use drugs, but then find out that they don’t
know how when they are being pressured to do so in social situations. Now, in this model,
note the centrality of intentions. That’s because there can be a substantial gap between
one’s intent to behave in a certain manner – for example, for a student to hand in a
homework assignment – and the behavior itself. The student might get sick, or miss the
bus, or simply lack the skills and knowledge to finish a homework assignment, no matter
how well-intentioned.
Behavioral Intentions in TPB has three key components:
1. Attitudes, which are based on behavioral beliefs;
2. Norms, which are based on normative beliefs and motivation to comply; and
3. Self-efficacy, which is based on efficacy beliefs.
Note that two boxes are not mediated through intention to behave: Skills and environmental
constraints. Skills and environmental constraints both act on behavior independently of
intentions. That is, no matter how much you intend to behave in a certain fashion, you
may not be able to if you don’t have the skills to behave, or if there are constraints or
impediments in your environment that make you unable to behave.
The Attitudes pathway begins with the box on the upper left in dark blue titled “behavioral
beliefs and assessment of the consequences of behaviors.” People’s attitude towards a
certain behavior is their overall evaluation – in the sense of determining the “value” or
“worth” to them of the behavior. Is the behavior desirable or undesirable? Good or bad?
In TPB, attitudes are based on two important components. The first component is that
behavioral performance will be associated with a certain outcome or expected result
that is, the degree of certainty that if you do this, it will have that effect. The second

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Managers and Supervisors Course 05: School-based Prevention Interventions
component is that the outcome or result will have a certain value – for example, it will be
good for you, or you will enjoy it, or (perhaps) you won’t. Thus you may have a positive
attitude towards cigarette use, which is based on the belief that if you smoke cigarettes,
you will impress other adolescents with whom you would like to be friends, and that
because you feel isolated, having a friendship network would be very important to you.
Or you may have a positive attitude towards alcohol use, which is based on the belief that
if you drink alcohol you will feel intoxicated, and you quickly discover that intoxication is a
good feeling. By the same token, you might just as quickly discover that you don’t like the
taste of alcohol or it makes you feel sick. So these are all evaluations of the consequences
of behavior.
The Norms pathway starts with the deep blue box titled “Normative beliefs and the
motivation to comply.” TPB also suggests that people intend to behave in a certain
manner because they believe that other people, and especially people who are important
to them, would approve – or disapprove – of what they are considering doing. This belief
is called a subjective norm. Like attitudes, subjective norms derive from two components.
The first of these is a normative belief, which is a belief about whether other people would
approve or disapprove of the behavior in question. The second is motivation to comply,
which is the extent to which people believe that they should do what they believe that
others think they should. Consider two examples. First, think of the decision to smoke.
If you know that your parents and teachers think you should not smoke, then you may
be less inclined to do so. But if you don’t care what your parents and teachers think, and
believe that what other students (your peer group) thought was more important, then
the subjective norm constraining your tobacco use would be weak. Now, let’s turn to the
alcohol example. You may know that your parents and teachers don’t want you to drink,
and if you are strongly attached to your school and enjoy a close bond with your teachers,
you may not want to disappoint them by being caught drinking. So it should be clear that
your attitudes towards a behavior, and your perceived subjective norms concerning the
behavior, could easily pull you in different directions as you decide or form your intent as
to whether to drink or smoke.
The third component of the model is called Self-efficacy, which has to do with a person’s
overall assessment as to whether the person can or cannot actually perform the behavior.
This pathway starts with “efficacy beliefs.” In regard to efficacy beliefs, consider each
step needed to smoke a cigarette, or drink a glass of alcohol. If there are no cigarettes or
alcohol available in the home, a person would need to ask an adult or friend to get it or
buy it. This may present a considerable challenge, especially if you don’t know any adults
or had any friends who smoked or drank. Or there may be some risk in asking an adult
to buy alcohol or drugs for you. They might tell someone in authority that you had done
so. Or you may not think you have the skill to approach someone and ask for alcohol or
cigarettes. So the behavior in question might be quite challenging for some, while it won’t
be for others, if all they have to do is sneak some beer out of their parents’ refrigerator.
The fourth component of the model is Skills. People may wonder if they have the self-
efficacy, or the skills and confidence, needed to perform a behavior, but, of course, they
have to actually be able to do it if they are to succeed – that is, a person’s perceived self-
efficacy to perform a behavior may be high – but they may lack the necessary skills. Which

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 is why you see, in the model, a direct arrow between Skills and the Behavior itself, which
means that the effects of skills are not mediated by (or pass through) intentions to behave.
If you simply don’t have the skills to approach a stranger, when you are a child, and ask
him or her for alcohol or drugs, then you won’t get very far, even if you believe you have
the self-efficacy to do so. Self-efficacy is a subjective, personal judgment, whereas skills
are objective in nature – you either have them in sufficient quantity to do what you would
like or you don’t. You may want very much to smoke as a child, and believe that you have
the self-efficacy to do so, but if you start coughing violently after the first puff you won’t
get very far.
Finally, behavior is a function of what are called Environmental Constraints– elements
of the environment over which a person intending (or expecting) to behave in a certain
way has little or no control. We have already examined one example of an environmental
constraint – lack of cigarettes and alcohol in the home. If the shops in a child’s neighborhood
are careful about checking the age of purchasers of alcohol and tobacco products by
routinely asking for a driver’s license or other identity card, then a child cannot buy them
directly. On the other hand, if these products are readily available at the children’s school,
they should have little difficulty turning intention to use into actual behavior.

Key Principles of School-Based Prevention Interventions

The School Environment
We are now going to begin integrating the theories of cognition and learning and
the Theory of Planned Behavior and their application to school-based substance use
prevention interventions. The school like other institutions is not just a building and
furniture. It is also not only a place of learning, it includes people—students and school
staff—who interact throughout much of the day. So, similar to the home and parents
interacting with the child in family prevention interventions, the school setting and
staff interacting with students provides the opportunity to deliver effective substance
use prevention interventions. These interventions include: Classroom curricula; school
policy, and school climate. Most of the focus, however, is on curricula which have been
found to be the most effective in producing long-term prevention outcomes.
A substance use prevention curriculum means a classroom-based program with a
manualized set of activities to meet specific learning objectives. Substance use prevention
school policies refer to a set of written rules or regulations regarding substance use in
the school and on school grounds. These rules include the definition of any infraction--
which means what happens when someone breaks the rules, and the consequences of
infractions. Finally, school climate is defined by the national school climate center as the
“quality and character of school life. School climate is based on patterns of students’,
parents’ and school personnel’s experience of school life and reflects norms, goals,
values, interpersonal relationships, teaching and learning practices, and organizational
structures.”

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Managers and Supervisors Course 05: School-based Prevention Interventions
Research on Effective School-based Prevention
There are over two decades of research and evaluation in schools that demonstrate
which interventions work and which are not supported by the evidence. Many of these
Interventions are theory-based, and most of their components fit neatly into one or more
boxes of the overarching theoretical model, the Integrated TPB. The results of all these
studies have helped to identify the key components of effective substance use prevention
programs, and how these programs should be delivered if they are to be effective. The
studies have also shown for what specific populations of children and youth, and at
what ages these interventions are effective. This issue is of great importance, because
the developers of some prevention programs that have been successfully tested with a
certain population – say, early adolescents – have suggested that their program may be
appropriate for older or, more likely, younger children. Or developers may develop and
disseminate a different program, with the same name, that targets children who are either
younger or older. The point to be made is that Prevention Managers and Supervisors
need to be sure that the version of a prevention intervention they select for a specific
population has been evaluated with reference to that population. Just because developers
have modified an evidence-based program to make it appropriate for a younger or older
population does not mean that it will be found to be effective when tested.
Further, many prevention interventions show positive effects immediately following their
conclusion, while fewer show effects, if assessed, one year later. To what extent is this
a problem? Clearly, it is desirable for effects to last years, rather than months (or even
weeks), and all other things being equal, it is always best to select programs that have
demonstrated long-term effects. But even programs that are limited to short term effects
can be considered successful if they delay the uptake, or initiation, of key substances like
inhalants, alcohol, and tobacco whose use has been found across cultures to be associated
with the use of other psychoactive substances. In addition, some have argued that it may
be inappropriate to expect prevention programs to have lasting effects, when students
are constantly flooded with inducements to use substances in their social environments,
and see adults using and enjoying substances like alcohol and tobacco, without obvious
adverse consequences. It may be unreasonable to expect that a single inoculation
against substance use – even by an evidence-based program that is administered for
example in 10 to 12 weekly 45-minute sessions each – should be considered sufficient.
Age- and developmentally-appropriate substance use prevention interventions need to
be integrated into the entire school context, from kindergarten through the end of high
school, both within and outside the classroom.

Developmental Stages and Learning

One of the key principles of effective prevention interventions is a recognition that the
objectives and strategies need to target children’s and adolescents’ stages of development,
including what they need to learn, in addition to addressing the vulnerability and resilience
factors that place them at risk for substance use. The following describes these for middle
childhood and adolescence.

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 Middle childhood
Middle childhood generally includes children around age 6 through 11 years – elementary
school age. Middle childhood is a period when children acquire the skills needed to relate
to the world outside of their families mostly in school settings and with same age peers.
While the family remains the principal source of safety and support, day care, school
and peer groups begin to take on an increasing role in influencing the beliefs, attitudes,
and behaviors of children. As the brain continues to develop, emergent cognitive and
emotional regulatory functions become key during this period. Children learn to maintain
attention, control their emotions, and are more open to new people, even those who
look different from them. They become more receptive to new ideas and behaviors, more
effective in communicating their needs and ideas, and more accurate in identifying and
labeling emotions. During this period, children continue to increase their language and
numeracy skills. By being able to better identify their needs and their emotions, they
begin to control impulsive behaviors and practice self-control. They develop goals and
are better able to plan behaviors to achieve these goals, and begin acquiring decision-
making and problem-solving skills.
While children in this age group are increasing their cognitive, emotional, and social
competencies, there are also challenges that could put vulnerable children at risk.
Children are spending more time away from their families and are being exposed to
new ideas, new behaviors, and new experiences. This may be confusing for unprepared
children. This is why clear prosocial community norms, school culture and quality of the
educational experience become so important. It is during middle childhood that the
role of social skills and having prosocial attitudes grows in significance. Factors that may
impede achieving developmental goals may be within the child, such as the onset of a
mental disorder or outside of the child, such as coming from a dysfunctional family that
may make the child more dependent on peers. Young children who are just entering
school must learn a new set of roles and responsibilities at school, which include listening
to their teachers and following instructions. They need to develop communication skills,
which include when and how to speak – and when not to – and how to listen for and follow
their teachers’ instructions. Children must also learn – and fairly quickly – to manage
their impulses; that is, how to control and contain their emotions, and how, when, and to
whom to express their needs. From their first days at school, they are faced with complex
problems to solve and decisions to be made, to which they must respond appropriately.
Children not only learn how to behave with one another, but they also have to acquire
the skills needed to share objects and skills, and work cooperatively with other children
in teams to accomplish a given set of objectives. Children also must learn to understand,
respect, and accept interpersonal differences relating to gender, race, ethnicity, culture,
socio-economic status, and physical appearance.
Effective interventions. For this age group, three interventions and a prevention policy
have fairly good indication of efficacy: Parenting skills programs, personal and social skills
education, classroom environment improvement programs, and policies to keep children
in school, all target universal groups. All of these programs can and do involve the school
setting. Parenting skills programs generally recruit parents from schools working with
school administrators or may actually be delivered in the school setting. Personal and
social skills education refers to substance use prevention curricula. Classroom environment

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Managers and Supervisors Course 05: School-based Prevention Interventions
improvement programs and policies address the school climate. These three strategies
have been tested in universal populations that include populations where individual risk
or vulnerability is not known. Policies to keep children in school have also been evaluated
with vulnerable children.
Some years ago the U.S. National Institute on Drug Abuse sponsored a guide to research-
based practice, based on findings from a multitude of research studies of the effects of
prevention programs that the Institute has sponsored over time. Here are some of the
principles specified in the guide. School-based substance use prevention interventions
should target children at various developmental levels and for middle school should
focus on: Self-control, emotional awareness, communication, problem-solving in social
situations, and the provision of academic support to develop reading skills.

Adolescents
Adolescence is a period of many challenges as the brain continues to develop in
the context of hormonal and other normal biological processes. The adolescent
developmental period is fraught with stress and erratic emotions that can lead to poor
decision-making thus increasing the likelihood of engaging in risky behaviors that may
have negative health and social outcomes. This developmental period focuses on the
enhancement of self-regulation and control of emotions and behaviors. This is a period of
learning those social and emotional skills that enable people to establish stable intimate
relationships with others, to be more sensitive to the feelings and needs of others, as well
as, learning to control anger and aggressive feelings to handle conflicts in a positive way.
As noted earlier, children mature into these early teen years, their physical and emotional
development can often place them at increasing risk of negative influences or resilient as
it strengthens their ability to resist such opportunities.
This is an exciting time for adolescents. First is the exposure to a broader array of people
and organizations that may present new ideas and experience, perhaps challenging
those that the child may have held for a long time. This is a time when youth want to
try out adult roles and behaviors including use of alcohol, smoking, perhaps sexual
behaviors, and drugs. Second, this is a time when significant changes in the adolescent’s
brain take place. This is often a time when poorly reasoned decisions are made leading
to involvement in harmful behaviors. But it also provides opportunity for learning new
cognitive and emotional skills that help them navigate the difficult challenges they will
face. Here again we see the positive and negative influences that can affect adolescents.
While peers can have a great influence over what they think, wear, and consider ‘cool,’
and the fear of peer rejection can be a powerful motivator, parents still have influence and
other prosocial learning can be a protective factor. After all, this is a period when children
are open to new ideas. And, although the plasticity and malleability of the brain presents
opportunities for poor decisions, it also presents opportunities for prevention with well-
constructed and well-implemented interventions to reinforce and heighten prosocial
attitudes and behaviors.
In early adolescence, the culture and environment of the school become even more
important as a setting in which to teach a variety of key life skills. These include decision-
making and problem-solving, the ability to regulate impulses and emotions, and shaping

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 and rewarding positive behaviors – and in sanctioning inappropriate behaviors. At this age,
children should be able to accept responsibility for their behavior and its consequences.
They should also be able to develop and maintain friendships, and communicate
effectively with their teachers and peers. They should understand their own core values
and attitudes and, when making decisions, be able to anticipate whether a particular
behavior will reflect, or run contrary to, these values and attitudes. They should also be
able to understand the forms that peer invitations to behave in an anti-social manner may
take, and respond in an effective manner to these inducements.
Effective interventions. There are many more evaluation studies of interventions that
address the needs of this age group. Parenting skills programs remain effective for
this group as well as personal and social skills based curricula, and policies within the
school, all of which address the needs of universal student populations. For more at risk
populations, interventions that provide individual attention such as those that address
psychological vulnerabilities have adequate evidence of effectiveness. Programs should
focus on: Building communication; increasing self-efficacy, assertiveness, and substance
use resistance skills; helping students build positive peer relationships and personal and
social skills; reinforcing antidrug attitudes; and supporting their study habits and academic
achievement. Many groups have published guidelines on good practice in school-based
substance use prevention interventions. Here is a summary of what works prepared by the
United Nations Office of Drugs and Crime and the European Monitoring Center for Drugs
and Drug Addiction. Labeled as “beneficial” are social influence-based interventions for
alcohol and cannabis use. Identified as “likely to be beneficial” are interventions that use
interactive vs. non-interactive (didactic) instructional styles that are implemented over 10-
15 weekly sessions, delivered by a trained facilitator, comprise multiple components; are
school-based alcohol-specific prevention programs targeting alcohol use, or are skills-
based interventions to reduce substance use and to improve decision-making.

The “Basics” of School-Based Prevention Interventions

The “basics” of substance use prevention interventions include: Their Content – what’s
in them; their Structure– how they are typically organized; and their Delivery – how they
are taught, which can be the most challenging. Here are some additional key principles
regarding substance use prevention, all of which also map onto the TPB integrative model
of the determinants of behavior presented earlier.

Content
Many programs include components that address the negative consequences of
substance use, sometimes for substances of specific concern. Information concerning
negative consequences relates to behavioral beliefs. However, efforts to change behavior
by specifying negative consequences are unlikely to have a substantial effect on attitudes,
which are mediated by the relationship between behavioral beliefs and behavior. If the
students targeted do not perceive these consequences as much of a threat (that is, the
evaluative aspect of behavioral beliefs), it will not have much of an effect on their behavior.
For example, students might think or know they could become dependent on marijuana,
but this information doesn’t apply to them because they don’t intend to smoke very much;
and, besides, lots of other people start and stop smoking the drug without any apparent
ill effects.
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Managers and Supervisors Course 05: School-based Prevention Interventions
Often there is a component that teaches a way to critically analyze media advertisements
to help students understand the point of view and purpose of advertising—usually to
glamorize and “sell” the products--and how that can affect one’s behavioral beliefs and
attitudes, especially in regard to alcohol and tobacco.
The model suggests that establishing social norms that substance use in the school is
inappropriate – the model’s normative belief component - will have little effect if the
student’s bonds to the school are weak, so that motivation to comply with what staff and
peers at school think you should do is minimal. However, changing misperceptions that
substance use by peers is high will likely affect positive subjective norms. Strengthening
personal commitments not to use substances relates to the behavioral intention box if
the intention constitutes a promise the students make to themselves. Students who make
a public commitment – perhaps in the presence of other students – will, again, be more
likely to keep the commitment if their peers’ judgments concerning their willingness to
keep their commitments are important to them.

Structure and Delivery

School-based substance prevention curricula are typically designed for 10 to as many as 15
weekly sessions, sometimes with a culminating “graduation”. Each session is developed
to fit into a single class period of about 45 to 50 minutes. There is little evidence that
teaching classes more frequently will reduce program effects, but if there is homework
for any particular class sufficient time should be allotted between classes for students to
do the work. Each lesson tends to be highly structured. Lessons tend to begin with an
overview of what students will learn that day, and then move through a series of carefully
scripted lectures, demonstrations, class discussions, and small group work, and then end
with a summation of what the students have learned. There is plenty of evidence that
teachers need to follow curricula guides very closely if the program effects are to be
successfully realized.
Training. Because fidelity to the course is so important, teacher or facilitator training
to support the implementation of the course as intended by the developer is essential.
Typically this training process will require an entire day, and sometimes two. While in-
person training is probably superior to training via the net, the evidence supporting one
relative to the other is lacking: but net-based training is almost certainly better than none
at all. In addition each lesson builds on the prior lesson thus escalating and enabling. This
is called “spiraling”. Finally, the course should support the application of knowledge and
skills in role play or discussions.
Interactive teaching and facilitation skills. Perhaps the most challenging requirement
of teaching substance use prevention curricula are the interactive instructional methods
typically required, as opposed to didactic instruction (Ringwalt, 2010; Horsley & Loucks-
Horsley, 1998). In order for a truly interactive teaching strategy to work – that is, to
achieve the objectives of the substance use prevention course selected – the teacher
must establish an atmosphere in the classroom that is accepting, non-threatening, and
non-judgmental. Students must feel safe within the classroom context to express what is
on their minds. The teacher must also be able to facilitate a class discussion that stays on
target – that is, focuses on the achievement of the objectives of the discussion as stated

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Prevention
 in the course guide – and fits within the limited time allotted to it. Particularly challenging
will be students who may wander off topic and risk subverting, or hijacking, the discussion,
particularly if they self-disclose information about themselves, their families’, their peers’
substance use, or ask inappropriate questions that may be designed to embarrass the
teacher – perhaps about his or her own history of substance use.
Thus in this context, “facilitate” also means “manage effectively.” This can be done by
establishing rules and guidelines about acceptable participation behavior. Another key
part of discussion facilitation is recognizing and verbally rewarding students’ ideas, so that
students who contribute to the discussion in a meaningful manner feel encouraged and
validated. The teacher must also be comfortable asking appropriate follow-up questions,
or probes, that are designed to help the students think further about, and elaborate on,
what they have just said – if the content of their comments is pertinent to the particular
objectives of the class discussion. Finally, teachers must be able to effectively create
and manage several concurrent small groups in such a way that all students participate,
practice the personal and social skills they have been taught, and express themselves
freely and openly.
The specific skills that are needed to support interactive discussions, starting with open-
ended questions. In responding to students’ questions or comments that are unclear,
teachers should consider restating the question. This strategy not only validates the
student asking the question, but it gives the teacher the opportunity to consider whether
the question is an appropriate one to answer and, if it is not, to rephrase it in such a
manner that it becomes more so. The teacher then needs to decide whether to answer
the question personally or to invite the class to address it. Teachers should also feel
comfortable asking open-ended questions that invite students to consider what they
have just learned. One of the best probes to open a discussion is “How would you apply
what we just learned to your life?”, because it stimulates reflection about and integration
of the content, especially if it relates to a new personal or social skill.
Teacher training and preparation. Good facilitation also means that teachers should
be able to demonstrate enthusiasm for, and mastery of, the material they present.
Teachers who deliver a substance use prevention course with a flat voice, in a monotone,
will probably not be very effective – any more than they would be effective in teaching
other types of course content. But they should also be familiar, and comfortable, with the
content they are teaching. Hence the importance of teacher training, and the need to
review the content of each lesson prior to delivering it. A fair amount of conceptual and
research attention has been paid to how teachers progress from one stage to another
in their ability to deliver educational curricula effectively. Teachers generally begin with
rote recitation (e.g., reading out of the teacher’s manual) and then progress to mastery
– when they are able to use their own words to deliver the course without straying from
the developer’s intentions and instructions. Teachers’ implementation and delivery of
classroom substance use prevention curricula should be independently monitored to
ensure fidelity which is important. Teachers should also introduce, complete, summarize,
and link together all learning experiences in each session. There is some very old advice
that, in presentations, you should “tell them what you are going to tell them, tell them, and
then tell them what you told them.” Adults hate being on the receiving end of this, but for

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Managers and Supervisors Course 05: School-based Prevention Interventions
younger students it remains sound advice. Teachers should manage time very carefully to
ensure that they can complete their summary and the learning for that session..
Small group work. Issues about forming and managing small groups are also important
(Poulin, 2001). First, students must be carefully sorted into groups in order to distribute
fairly evenly those with leadership potential, those who are quiet and will need support
and encouragement if they are to make a contribution, and those who are potentially
disruptive. This last one is particularly important because grouping together antisocial
or disruptive adolescents in a group context makes them worse, not better. Before they
break up into groups, all students should be made fully aware of the purpose of and goals
of the exercise, the roles that each of them is expected to play (e.g., facilitating, reporting
out to the whole class), the steps they should follow, and the amount of time specified for
each step. That is, their session together should be highly structured. At the conclusion
of the exercise, students should be actively encouraged to reflect on how what they have
learned applies to their daily lives – in the absence of this connection, the exercise is likely
not to be effective.

What Doesn’t Work in Prevention

Three decades of evaluations of school-based substance use prevention curricula has
also taught us a great deal about what does not work (Lemstra et al. 2010; EMCDDA
Best Practices Portal; UNODC Prevention Standards, 2013). This is almost as helpful as
finding out what works, because many schools have wasted a lot of time and resources
on prevention programs and strategies that have no evidence of effectiveness, and some
program evaluations have found results that are exactly the opposite of those that were
expected.
Lecturing and “knowledge only.” First, as discussed above, lecturing does not work
and teaching knowledge about substance use alone will not directly change behavior.
Teachers need to be a “guide on the side, not a sage on the stage.” Also ineffective, as
we have seen, are unstructured class discussions, when it would be easy for the teacher
to lose control of the class (as well as the amount of time allotted for the discussion). This
is what can happen. The topics discussed can veer off in any and every direction: For
example, students’ disclosure of their (or their friends’ and families’) illegal drug taking
behaviors and what happened next. If it were to occur, this type of self-disclosure may
make the student the subject of gossip by their peers, or subject them to sanctions by
their school. Either way, self-disclosure can be dangerous, and to allow it to occur is clearly
unethical. Students may also start asking questions of their teachers about what substances
they used when they were young. Also generally considered ineffective are efforts to
increase students’ knowledge by providing facts concerning specific substances, such as
amphetamines (speed) or crack cocaine. For example, a well-meaning school staff might
hold up a poster that displays pills that represent various types of controlled substances,
and then describe their effects. Such efforts may merely serve to make students more
intelligent consumers of prescription drugs. For that reason, some prevention curricula
barely mention specific substances at all, although that may be difficult in a school with an
epidemic of a particularly popular substance, where the school’s administration may be
eager to include one or more lessons that pertain specifically to this substance.

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Prevention
 Peer-led groups, boosters, posters/pamphlets. Several other strategies have shown
little evidence of effectiveness. For a time schools were excited about the notion of using
students instead of staff to teach substance use prevention curricula. The notion for this
approach was that younger students would relate and listen better to their older peers
than to adults. But tests of which teaching method is better have proved inconclusive.
Also generally ineffective are booster substance use prevention sessions delivered (often)
a year after the initial course was completed. The notion for doing so was, and remains,
compelling, and is often considered a “best practice.” Why should one expect prevention
curricula to have an effect over multiple years if there are no follow-up lessons, like a
booster shot for an immunization? Particularly as one of the principles of effectiveness
in substance use prevention is to continue to disseminate anti-substance use messages
in all school grades. Unfortunately, boosters have not been shown to make much of a
difference. It isn’t really known why this is so. But it is possibly because they have sometimes
been delivered by different teachers in higher grades, who may have little understanding
of the nature and purpose of the lesson or the booster material may not consider the
developmental needs and experiences of the now older students. Or they may not have
been well-connected to the lessons that were delivered in the earlier sessions. Also found
to be “ineffective” are posters and pamphlets, which (again) typically seek to increase
knowledge, but may or may not be read or (even if they are) properly understood.
Ex-drug users, self-esteem. Also ineffective as a substance use prevention strategy is the
use of ex-drug users, or indeed motivational speakers of any type, to provide testimonials
or other types of speeches about substance use. While one-time events of this nature
may be particularly popular with schools, insofar as they are cheap, easy, popular, and
do not require much class time, these individuals simply lack credibility with increasingly
sophisticated student audiences. If they talk about the horrible consequences of substance
use, students will discount what they say, because most students know others who take
substances without any apparent bad effects. Besides, young people generally believe
that they can “handle” any substances they take. At worst, the testimonials of former or
recovering substance users can inadvertently promote substance use by glamorizing the
dangers that the speaker faced when still a user (or, perhaps, a dealer). Or the students
may think “you used drugs, were treated and you are okay. So what’s the problem?”
Also lacking evidence of effectiveness are programs that build self-esteem. Self-esteem
strategies failed for at least two reasons: It is very difficult to change self-esteem within
the context of a course, and the relationship between self-esteem and substance use is
weak – substance using students, indeed, may have a very positive sense of themselves.
While there is no harm in seeking to increase students’ self-esteem, it should be part of
a much more comprehensive set of objectives. But where would self-esteem fit into the
integrative model of the determinants of behavior?
Random drug testing. Another ineffective popular strategy is random drug testing.
Despite its considerable cost, many people supported the widespread dissemination of
drug testing because of its potential as a deterrent. The reason for the support of this
approach was that if students knew they were likely to be tested for the presence of a
variety of substances, they would be less likely to use and, indeed, would have a credible
excuse not to use if invited to do so by peers. But controlled evaluations of the effects of
drug testing have generally failed to yield anticipated effects – perhaps because students

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Managers and Supervisors Course 05: School-based Prevention Interventions
knew that the likelihood that they might be tested in any given week was relatively low.
This is not to say that drug testing is never useful – it certainly can be quite effective as
a prevention tool not an intervention. This is particularly relevant within the context of
students who are being subjected to testing for cause – that is, when they have been
suspected of using (or have previously been identified as users) and are being monitored to
ensure that they are remaining drug-free. But from the perspective of primary prevention,
drug testing has not been found to be effective particularly in relationship to its costs
and the burdens associated with administration. These include not only the cost of the
test itself but also monitoring students while they provide samples, and then establishing
what is called a “chain of custody” to ensure that samples are not mislabeled or lost.
Media-based ‘scare tactics,’ and one-time events. Two more examples of what doesn’t
work include scare tactics and single event activities. In general we have learned from years
of research on persuasive messaging that scaring people does not deter or encourage
behavior. We will learn more about this research in the Course on Media-Based Prevention
Interventions. What we know from the studies on use of scare tactics in the past is that
these programs fed youth a lot of misinformation concerning the consequences of using
various types of drugs, which contradicted their own experience and that of their peers.
As a result the adults providing these messages lost all credibility.
One final strategy to avoid constitutes any stand-alone, single event activity. Examples
might include: Motivational speeches, fairs, speech/poster contests, and drug-detecting
dogs. The concept here is that they cannot take the place of activities that are ongoing,
comprehensive, and developmentally appropriate—the more effective and desirable
approach.

References
Botvin, G.J. and Griffin, K.W. (2003). Drug Abuse Prevention Curricula In Schools. In
Sloboda, Z. And Bukoski, W.J. (Eds.) Handbook of Drug Abuse Prevention: Theory,
Science, And Practice, Pp. 45-74). New York: Kluwer Academic/Plenum Publishers.
European Monitoring Centre for Drugs and Drug Addiction. Best Practices Portal:
Prevention Interventions for School Students. Available at: www.emcdda.europa.eu/best-
practice/prevention/school-children
Evans, R.I. (1976). Smoking In Children: Developing Social Psychological Strategies Of
Deterrence. Preventive Medicine, 5, 122-127.
Evans, R.I., Rozelle, R.M., Mittelmark, M.B., Hansen, W.B., Bane, A.L., And Havis, J. (1978).
Deterring The Onset Of Smoking In Children: Knowledge Of Immediate Physiological
Effects And Coping With Peer Pressure, Media Pressure And Parent Modeling. Journal of
Applied Social Psychology, 8, 126-135.
Glanz, K., et al. (2002) Health Behavior and Health Education: Theory, Research, and
Practice. 3rd Edition. San Francisco: Jossey-Bass.
Glanz, K., et al. (Eds.). (2008). Adapted from Health behavior and health education: Theory,
research, and practice. John Wiley & Sons, page 155.

Participant Manual: Module 5—Applying Theory to School-Based Substance Use 245

Prevention
 Lemstra, M., et al. (2010). A systematic review of school-based marijuana and alcohol
prevention programs targeting adolescents aged 10-15. Addiction Research & Theory,
18(1), 84-96.
National Institute on Drug Abuse. (2003). Preventing Drug Use among Children and
Adolescents: A Research-Based Guide, 2nd edition (NIH Publication No. 04-4212(A)).
Available at: http://www.drugabuse.gov/sites/default/files/preventingdruguse_2.pdf
Poulin, F., et al. (2001). 3-year iatrogenic effects associated with aggregating high-risk
adolescents in cognitive-behavioral preventive interventions. Applied developmental
science, 5(4), 214-224.
United Nations Office on Drugs and Crime. (2013). International Standard on Drug Use
Prevention. Vienna, Austria: UNODC. Available at: http://www.unodc.org/unodc/en/
prevention/prevention-standards.html

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Managers and Supervisors Course 05: School-based Prevention Interventions
 MODULE 6
SELECTING AND ADAPTING THE RIGHT PREVENTION
PROGRAM FOR YOUR SCHOOL

Content and timeline .....................................................................................248

Training goals and learning objectives .........................................................248
Introduction to module 6 ...............................................................................249
PowerPoint slides ...........................................................................................250
Resource page ................................................................................................300
Summary..........................................................................................................302

Participant Manual: Module 6—Selecting and Adapting the Right Prevention Program 247
for Your School
 Content and Timeline
Person
Activity Time
Responsible
Introduction to Module 6 15 minutes
Presentation and discussion: Getting started in
30 minutes
schools
Presentation: Selecting programs and strategies 5 minutes
Large-group discussion: Experience in schools 30 minutes
Lunch 60 minutes
Presentation: Factors affecting program adoption 10 minutes
Presentation and discussion: Evidence-based
substance use prevention curricula: Standards for 30 minutes
selection
Presentation: Using registries to find EB interventions 30 minutes
Large-group exercise: Blueprints demonstration 60 minutes
Break 15 minutes
Presentation and discussion: Examples of ‘what works’
15 minutes
in prevention: Life Skills Training
Presentation and discussion: Examples of ‘what works’
15 minutes
in prevention: Project Toward No Drug Abuse
Small-group exercise: Compare these interventions 20 minutes
Presentation and discussion: Fidelity vs. adaptation 40 minutes
Large-group discussion: Cultural adaptation 20 minutes
Reflections 10 minutes
Wrap-up and Module 6 evaluation 15 minutes
End of Day 4
Total Time = 420 minutes (7 hours)

Module 6 Objectives
Learning objectives
Participants who complete Module 6 will be able to:
„ Describe the difference between “evidence-based” and “best” (or “promising”)
practices related to school-based substance use prevention;
„ Demonstrate an understanding of how to use a key registry of evidence-based practice
to select a prevention program;

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Managers and Supervisors Course 05: School-based Prevention Interventions
„ Describe two examples of evidence-based curricula, LifeSkills Training and Project
Towards No Drug Abuse;
„ Describe how and why teachers sometimes adapt prevention curricula, and what types
of adaptations are likely to be helpful or unhelpful; and
„ Discuss how to monitor teacher fidelity to prevention curricula.

Introduction to Module 6
Module 6 will focus on helping you “get started with prevention.” One of the first steps is
to use your knowledge from Module 4 to document the nature of substance use in your
school or community to build the case for prevention. With that case, you might then
reach out to stakeholders to work with you to develop a plan. Then you might identify a
“champion” to lead the effort. But once that is underway, there are several other areas
you need to consider before actually selecting the program that would be right for your
school.
The module recognizes the importance of “school readiness” in deciding to undertake
a new course for addressing substance use. Readiness involves everything from
administrative support to financial and time resources and for training the teachers.
Also, as suggested above, it is important that everyone recognize that substance use is a
problem before they’re ready to adopt a new program.
The module will also brief you on the standards for identifying evidence-based
prevention interventions; and, specifically, the UNODC International Standards for Drug
Use Prevention. This process of systematic decision-making using research data means
that there are a select few interventions which are eligible for such a designation. As
a prevention professional, you will continue to gain knowledge and expertise on how
research is conducted to qualify for evidence-based status. The module will overview
the most effective types of evaluation for prevention interventions to produce positive
results. These include:

„ Randomized control trials „ Single group

„ Interrupted time series „ Post-test only
„ Matched comparison group „ Case studies
You will learn how to search registries to identify eligible interventions. You will be
introduced to two school-based prevention curricula that have been found to be effective
after many years of research: LifeSkills Training and Project Towards No Drug Abuse.
You will have the opportunity of reviewing the features of these interventions and to see
what makes them work for prevention.
Lastly, you will explore the issue of fidelity vs. adaptation of interventions to understand
some of the trade-offs as you consider what would be best for your community. You will
explore the concept of core content which must be retained to ensure effectiveness, and
cosmetic changes that can improve acceptability to the target audience.

Participant Manual: Module 6—Selecting and Adapting the Right Prevention Program 249
for Your School
 The Colombo Plan Drug Advisory Programme (DAP) Training Series
Universal Prevention Curriculum for Substance Use (UPC) Managers and Supervisors Series

Managers and Supervisors

Course 05
School-Based Prevention
Interventions

MODULE 6—SELECTING AND ADAPTING

THE RIGHT SUBSTANCE USE PREVENTION
CURRICULUM FOR YOUR SCHOOL



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Managers and Supervisors Course 05: School-based Prevention Interventions
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 Module 6 Evaluation
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 Resource Page 6.1: Logic Model for Life Skills Training

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Resource Page 6.2: Adapting a Prevention Program

„ Select an evidence-based program to be adapted;

„ Examine the program carefully for evidence of the need for adaptation due to
culturally-inappropriate content, e.g.
• Language;
• Pictures, graphics, symbols, or videos; and
• Concepts.
„ Review the program’s supporting literature to understand its evidence of effectiveness,
risk factors addressed, core components, teaching strategies;
„ Recruit and convene a working committee (2-4 people) which includes teachers,
interested stakeholders, students; plan on 4-6 meetings;
„ Modify the intervention;
„ Share the modified intervention with the program developer and ask for feedback;
„ Pilot test the adapted intervention; and
„ Examine the effects of intervention on students for engagement and understanding.

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 Summary of Module 6: Selecting and Adapting the
Right Prevention Program for Your School
Getting Started with Prevention
To get started in a particular school, it may be helpful to document the nature and extent
of substance use problems that the school or community is experiencing, and to identify
supports and barriers within the school and community that are pertinent to how the
school can address these problems. Among the problems that you may encounter is a
denial that the school and community that it serves even have a problem. Or there may
be some recognition of the problem, but the support, time, and resources to respond to
it are lacking. It may be helpful, then to develop a written or oral report that: documents
the nature and extent of the problem, with such data as are available, identifies supports
and barriers, and specifies a coordinated stakeholder strategy that involves the selection
of evidence-based prevention interventions.
After developing the overview presentation, the Prevention Manager and Supervisor needs
to organize and convene a school “committee of stakeholders” meeting. Stakeholders
who may be considered for this meeting include the school principal, teachers, school
board members, and concerned parents. But there may be other stakeholders interested
in participating in this group. Some of the following could be part of the meeting agenda:
Discuss how and why members of the committee became involved. These include to:
explore the reasons there is a need for action; present the overview that documents the
nature and extent of the problem, major issues, and how the committee can spearhead
evidence-based interventions that can make a difference; poll the committee to determine
people’s interest in becoming involved; and follow-up with personal communications with
each of these individuals.
Another aspect of importance to a program is identifying a “champion” at the school.
Research on the effectiveness of establishing a substance use prevention intervention in a
school has shown that having a champion for a substance use prevention program is key
to a successful effort to get schools to adopt, implement, and sustain it. The champion
should be someone who is well placed in regard to the school, and has the respect of
administrators and teachers alike. That does not mean that the champion must be a
member of the school’s administration, although that would greatly help. The champion
should have: Sufficient power (or “clout”) in the organization to make things happen;
rapport with the staff charged with implementation; and, sufficient time and resources to
coordinate implementation. The champion can serve in different capacities for the group:
motivator, coordinator and communicator.

Selecting Programs and Strategies for Prevention

There are many programs and strategies that schools can consider as approaches to
addressing their substance use problem. Some of these are: A substance use prevention
course; an approach to substance use that affects how the school and its classrooms
function, sometimes called a whole-school approach; and a review of policies related to
students’ and faculty’s substance use on campus and at school-sponsored events. There

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are no clear answers to the question as to which strategies, in which combination, are best
suited for any particular school. It is a matter of picking and choosing which strategies will
work the best within the school’s context – which includes the community’s, the district’s,
and the school’s support and resources available for the adoption, implementation,
and maintenance of the strategies considered. This module overviews substance use
prevention curricula, simply because there is more research evidence about them than
any other type of strategy. Also covered is a whole school strategy designed to assist
teachers manage their classrooms effectively. The next module covers the development
of policies that affect both students’ and staff’s substance use on campus and at school-
sponsored events. Note that these different types of strategies are fully complementary.
In fact, the more evidence-based types of prevention that a school put into place, the
more likely its substance use prevention efforts are likely to be successful.

School Readiness
One place to begin with school-based curricula is by assessing school readiness to adopt
and implement substance use prevention programs and strategies (Greenberg, 2005).
Here are some key questions to consider. Is there administrative support for making room
for substance use prevention programming during the school day? Is there human capital
with the requisite skills available to implement the programs? What about resources to
pay for materials related to programming, teacher training, substitute teachers to cover
classrooms during the training, and follow-up technical assistance? Is there high quality
training and technical assistance available to guide school personnel in implementing
prevention programs successfully, and in responding to challenges as they arise? All of
these factors should be assessed prior to selecting a prevention approach.
It is important that the administration of the school, and also the school district or regional
authority, to provide support for a particular program and provide leadership necessary
to ensure its effective adoption and implementation (Sloboda, 2014; Wandersman, 2008).
But many other factors should also be in place. The school should have articulated a vision
as to what kind of environment it seeks to be in order to support the educational and social
development of the students entrusted to its care. This vision should be accompanied
by related goals, one of which should be to ensure that the school environment is free
of alcohol, tobacco, and other substances. There should be plans for who will lead –
and thus be responsible for - the effort to adopt and implement prevention policies and
programs, and how that individual’s performance will be evaluated in this regard, and
how the evaluation will be related to professional advancement. The plan should include
an assessment of the ability of the school to implement the program. What teachers
or staff are required to do so? Do they have sufficient education and training? Are they
available? How much time will the program require, and of whom? Finally, there should
be an assessment of the organizational support available for the program. Some of this,
of course, relates to leadership – but there should also be a consideration of the nature
and extent of human and financial resources required to make the program work.

Adoption and Implementation

The characteristics of the program itself may affect its adoption and implementation.
These characteristics include the following. First, the school’s experience with programs
of this nature. If the program, and the concepts and requirements that underlie it, are

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 completely new to the school, there may be considerable resistance or skepticism related
to its adoption. It will be particularly challenging if the school has a tradition of either
ignoring substance use issues on campus, or addressing them by the occasional all-
school presentation, or simply expelling students involved with substances. Second, the
school’s attitudes towards the program. These could be positive, if there is a general
feeling that something of this nature is needed. They could also be very negative, if (for
example) the program takes time away from teaching traditional subject matter on which
teachers’ performance is rated. Third, administrative and teaching staff’s motivation to
use the program may be strong or weak. If they believe that “We don’t need this here” or
“This is not our responsibility,” effective program adoption and implementation may be
poor. On the other hand, if there is a clear understanding that substance use is a problem
at the school – and that a particular program is likely to be effective, than the school is
likely to be much more receptive to its implementation, and its chances for success will
be considerably greater. In this regard, it is important for whomever is introducing the
program into the school – who is, in effect, championing its adoption – to be well-versed
in the nature and strength of the research evidence related to it. There is a big difference
between saying, “Here is a program that has been implemented elsewhere. Let’s try
it.” and “this program has been recommended as evidence-based by the following
organizations and registries.”

Program Costs
Then there are the costs of the program to be considered. For some programs, these
costs can be considerable, especially if the program is proprietary – that is, not in the
public domain. There are likely to be start-up costs involved as well the costs of program
maintenance. These may include materials, such as teacher manuals, posters, and videos,
and student workbooks, which are sometimes called “consumables,” because you have to
buy a new set for each class, year after year. Then there is the need for staff training. There
is universal agreement that this is an essential prerequisite to effective implementation.
Traditionally, training has been conducted in person, although it is increasingly available
on line, which is considerably cheaper. There does not seem to be any evidence available
as to which is better, although there is reason to suspect that in-person training is superior,
since it gives the trainer the opportunity to model effective teaching and interact with the
class, and to invite participants to practice teaching a program’s sessions or activities.
There may also be a need for ongoing technical assistance. While there has been a lot of
conversation about the importance of technical assistance, we do not know much about
how effective it is, or even how much it is used. It would be desirable, of course, if teachers
who administer substance use prevention programs had someone to call or write when
they have questions or run into problems. But this can be expensive. It is also important
that someone be charged with monitoring the quality of program implementation.
Monitoring will be covered later--how important it is, and how to do it – but this can be a
very labor-intensive task if done well. If quality monitoring is no one’s job, then it is likely
that the program may be administered poorly and never take root in the school. The
opportunity costs, which means “What can’t you do because you are doing this, and what
are the likely benefits of what you didn’t do?” In the case of classroom-based prevention
programming, the opportunity cost can be quite high: 10 to 15 class periods that aren’t
devoted to teaching math, perhaps, or language.

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Evidence-based Substance Use Prevention Curricula:
Standards for Selection
With the school’s and community’s support for introducing a substance use prevention
curriculum it is necessary to find a suitable evidence-based course. Many curricula –
particularly those that are proprietary, and are for sale – may make claims about their
effects that the research does not fully substantiate. Hence it will be very important to
select the right course that meet’s your school’s needs by consulting an impartial registry of
evidence-based practice. In this regard, it is important to review the standards for judging
the quality and effectiveness of substance use prevention strategies. Until 2013 when
the United Nations Office on Drugs and Crime (UNODC) developed the International
Standards on Drug Use Prevention, no one body had reviewed and summarized research
findings from the prevention science literature.

Definition of Evidence-based
So what does ‘evidence-based’ prevention mean? Here is a definition of the Evidence-
Based Practice Institute of the University of Washington:
“Evidence Based Practice (EBP) is the use of systematic decision-making processes or
provision of services which have been shown, through available scientific evidence, to
consistently improve measurable client outcomes. Instead of tradition, gut reaction or
single observations as the basis of decision-making, EBP relies on data collected through
experimental research and accounts for individual client characteristics and clinician
expertise.”
There are two key aspects to this definition: A systematic decision-making using scientific
evidence that is associated with improved or positive outcomes, and reliance on data
collected through rigorous experimental research. This is a challenging issue, but a
general understanding of its complexities is required to understand why the experts
often – and quite legitimately – disagree as to what prevention programs and practices
can be called “evidence-based” as opposed to merely “promising” or “best” practice.
Generally speaking, the strength of methodological evidence that supports any given
prevention program may be expressed as a pyramid, with at least four or five levels. [Please
see Slide 6.21 for the pyramid.] The first and highest levels consist of meta-analyses and
systematic reviews, followed by randomized controlled experimental trials, interrupted
time series designs, matched comparison group (or quasi-experimental) studies, and
then other, weaker designs – which may still provide preliminary evidence that may be
sufficient to consider a particular prevention program “best practice,” especially if there
are no stronger alternatives available. No decision concerning the value of a prevention
program can, or should, be made on the basis of one evaluation only, no matter how
methodologically sound it is, and no matter how strong and convincing its results. Good
reviews select evaluations based on the quality of their methods.

Research Standards
Systematic reviews and meta-analyses. At the top of almost anyone’s hierarchy of criteria
for evidence-based effectiveness are systematic reviews of the results of multiple program
evaluations. The best systematic reviews use meta-analysis to aggregate, or pool, results

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 across studies, often using the common denominator of effect sizes for each pertinent
outcome of each study. Many meta-analyses generally develop an average indicator of
effect; differentially weighing the effect sizes of different studies, taking into account a
variety of factors, including the sample size of each study. The best meta-analyses can
be found in Cochrane Collaboration reviews (http://www.Cochrane.Org/). The Cochrane
Collaboration consists of a group on independent international researchers, practitioners
and others who wish to bring evidence-based practices to improve the global health
services. Examples of these that have been conducted in the school-based substance
abuse prevention field are included in the list of references and citations (Faggiano et al.,
2008; Foxcroft & Tsertsvadze, 2012; Thomas & Perera, 2006). Of course, systematic reviews
and meta-analyses are no better than the methodologies of the evaluations on which they
are based, so weak evaluations make for unreliable systematic reviews. We should also
mention that there is a strong publication bias towards programs that demonstrate effects,
so that good reviews need to include not just studies that are published in professional
journals, but reports that are self-published online.
Randomized controlled trial (RCT). At the top of everyone’s list of methodologically
strong evaluations is the randomized controlled trial (RCT), in which randomization occurs
at the school level (or sometimes the classroom or student level, within schools). The
whole purpose of RCTs is to make it as difficult as possible for evaluators to commit what
is called a Type 1 error. A Type 1 error is when an evaluator reports that a program is
effective, when it’s really not. This happens, typically, when there is an uneven playing
field – when something about the schools (or classrooms, or students)in the intervention
group is different from those participating in the control group. Random assignment
is the best way to promote (but not necessarily ensure) the equality of intervention
and control groups. That is, there is an equal chance that schools, or classrooms, or
students, will end up in the intervention group as in the control group. A second feature
of methodologically rigorous studies (like RCTs) is that there is low attrition, or loss to
follow-up. While some participants almost inevitably will drop out of an evaluation of a
school course, it should be as small as possible. If there is significant attrition, it should at
least be balanced across groups, so the intervention and control (or comparison) schools
remain as similar as possible
To continue the review of RCTs, a third feature is a baseline assessment or pretest,
followed by one or more follow-up assessments or posttests over time – the longer,
the better. The purpose of the baseline assessment is to find out if the two groups are
equivalent at the beginning of the study in relation to the variables measured and (if they
aren’t) to take any differences into account analytically when comparing posttest results.
A fourth feature comprises measures used to assess key constructs, like substance
use and related attitudes, social norms, and other variables. Are these measures valid?
Finally there is the analysis strategy; can you account for (or control) all the extraneous
factors that might contribute to any program effects you see? Another way of asking this
question is: Are those effects real, or have you committed a Type 1 error?
As we have seen, the RCT is the only design that allows the researcher to attribute any
findings to the intervention itself, and not to some other cause, like other contemporaneous
events to which any study findings could be attributed. But there are well and poorly

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conducted RCTs, of course. Here are some of the other factors that should be considered
in judging the quality of an RCT. Are the outcomes themselves meaningful? For younger
children who have not started to use substances yet, measures of knowledge, beliefs,
and attitudes may be appropriate. For adolescents, however, it may be appropriate to
hold prevention curricula responsible for changing substance use behaviors, not only the
precursors to or determinants of these behaviors. Are the measures of these outcomes
reliable and valid? That is, do they convince you that they do a good job assessing these
outcomes? Was fidelity to the intervention model assessed and, if so, did fidelity appear
high? Did the statistical analyses take into account all participants who were randomized
into the study, and not just those who were exposed to the intervention? This is sometimes
called an “intent-to-treat” analysis? How long was the follow-up post-intervention?
Interrupted time series designs. A strong alternative to the RCT is the interrupted
times series experimental design. In this design the intervention group serves as its own
control, so the evaluator examines key outcomes that occur both prior to and following
the implementation of a prevention program. What the investigator then does is to
examine changes in trend data collected both before and after program implementation.
The sharper the contrast between these two trend lines, the greater the investigator’s
confidence that the intervention is responsible for the difference. However, what this
design does require is a lot of data points both prior to and following the start of an
intervention. Supposing, for example, you implemented a whole school intervention that
was designed to increase attendance. If your school kept good records, you could then
examine attendance records, by month, for several years prior to and following program
implementation, which would give you sufficient data points to conduct a proper interrupted
time series analysis. However, this design does not control for contemporaneous events
that also might explain any study effects found, such as a change in how attendance
records were recorded over time. It’s a tricky design to implement well, and typically relies
on school records (rather than surveys), which is why we don’t see it used very often.
Matched comparison group studies. Further down the pyramid of evidence are
matched comparison group studies. No matter how well-matched these studies are, the
attribution of any effects found will always be uncertain. Typical matches occur by what
might be called “externalities” – things that are easy to measure and that serve to make
the control group like the treatment or intervention group, like age, race, ethnicity, and
sex. Less often measured – or measured well – are factors like whether the students or
schools that elected to participate in the intervention did so because they wanted to be
exposed to it. This is sometimes called “self-selection bias”, and it can cause substantial
problems in the interpretation of study findings. Consider, as an example, the principals
and teachers of two neighboring schools with similar students who have similar substance
use problems. One recognizes these problems and would like to do something about
them; the other would just like to pretend they aren’t there. The first eagerly enrolls in
the group that gets the intervention; the other serves as a comparison group. Now, if you
were a researcher, you could easily match these two schools on students’ demographic
composition and substance use at baseline. But could you honestly attribute any positive
study findings (for example, reduced substance use in the school that received the course)
to the course itself, and not to differences in the staff at the two schools? Wouldn’t you
be concerned that the energy, enthusiasm, and commitment of the staff in the first school

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 – and their connection to their students – may have made a lot of the difference? In
the end, all matched intervention-comparison group studies control statistically for the
characteristics and factors that the evaluator demonstrate at baseline are unequal across
groups, and thus making them as equivalent as possible.
Single group and other designs. At the bottom of the pyramid of evidence are a variety
of evaluation designs that are very limited in the evidence that they can yield, either
positive or negative, concerning the effects of a given program. Single group designs
(with the exception of interrupted time series experimental design, with all their data
points) cannot address whether any effects noted would have occurred in the absence
of the intervention. Post-test only designs, of course, cannot assess and thus control for
any differences between groups at the beginning of the study. Sometimes post-test only
designs ask respondents to remember back to what they thought or did prior to the
beginning of the study, but memories can be unreliable. The utility of case studies is
similarly questionable, although they can be useful to generate research questions for
future study.

UNODC International Standards for Drug Use Prevention

The International Standards for Drug Use Prevention was developed by the UNODC in
collaboration with an international group of prevention researchers. In developing the
International Standards, articles and reports of research studies were submitted and
reviewed against broad criteria to select the most relevant ones for further review. The
criteria included eligible studies, which reported on evaluations of effectiveness including
outcomes related to changes in the use of tobacco, alcohol, or other drugs; and, In those
cases where the intervention and policies target children through middle childhood,
before children typically begin to use substances, program evaluations could include
changes in mediating variables, e.g., attitudes, perceptions, and behaviors recognized in
prevention science as antecedents of the use of tobacco, alcohol, or other drugs.
Within the framework for each intervention and policy, a short description and rationale
for the intervention or policy is provided along with a summary of the evidence from
the review of the research. In addition, a list of the characteristics that were found to be
linked to positive outcomes as well as to no or negative outcomes is provided. It should
be emphasized that like a well-made cake, all of the components or ingredients to these
interventions and policies must be in place to be effective! In addition other relevant
guidelines, tools or resources are provided. Finally, the Standards include a chapter on
the critical components of a national drug control system that would support and sustain
evidence-based drug use prevention interventions and policies.

Using Registries to Find Evidence-based Substance Use

Prevention Interventions
So how do you find substance use prevention programs that do work? Fortunately, there
are several registries of evidence-based programs and practices in the substance use
prevention field. Their purpose is to assist district and school personnel in selecting the
best curricula that meet the particular needs of their student populations. These registries
identify programs with a strong empirical or evidentiary base, and the best of them have

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a searchable database so that you can enter key terms related both to the programs and
the searcher’s student population of interest. That is, they identify the populations on
which each program has been tested, which is particularly important because whereas
most prevention curricula have been tested on students aged 12-14, developers who
have created versions of the programs for younger or older students may suggest that
these programs are also evidence-based.
However, registries do have problems, and thus care should be taken in sifting through
the programs they represent. The criteria used for including a program under the
register may not meet high quality standards. First, they may rely on whatever evidence
of effectiveness is submitted by the individual or organization that has asked for the
review. Thus the evidence reviewed may not include the results of evaluations that have
not yielded evidence of effectiveness, and the published assessments also may not
incorporate new evidence that becomes available. Registries also vary as to how they
present evidence. For example, the National Registry of Evidence-Based Programs and
Practices, known in the United States as “NREPP,” summarizes program effects on key
outcomes – such as lifetime or 30-day substance use, or binge drinking, along with a
summary of the strength of the methodology used in the evaluations of the program. On
the other hand, “Blueprints” categorizes programs as “model” or “promising”.
Here are three registries that you may want to consult as you seek to find the right
prevention program for your school, its students, and the problems they are having
in regards to substance use. They are the: Blueprints for Healthy Child Development,
National Registry of Evidence-Based Programs and Practices (NREPP), and Preventing
Drug Use among Children and Adolescents.

Blueprints - An Example
Basic structure. Blueprints for Healthy Youth Development labels programs as either
“promising” or “model.” Promising programs meet minimum standards of effectiveness,
insofar as they specify clearly what outcomes they targeted – again, typically lifetime
and 30-day use of specific substances, but sometimes frequent use (for example, binge
drinking, generally defined as 5 or more drinks on a single occasion). They also specify
the characteristics of the populations targeted – for example, 6th or 7th graders. Model
programs meet more rigorous criteria and are mostly evaluated using 2 randomized
controlled trials or 1 randomized controlled trial and one quasi-experimental design.
In this registry, promising programs are supported by evidence from at least one
randomized controlled trial or two quasi-experimental evaluations. One type of quasi-
experimental evaluation is the matched comparison design in which an intervention
group that is exposed to a program of interest is matched to a comparison group that
is not, and then differences in characteristics between the two groups are controlled for
statistically, in an attempt to make the unequal groups less unequal. As you recall, these
designs are generally considered weaker than randomized controlled trials because they
cannot account for what is called selection bias – that is, that the students or schools in
the intervention group have chosen to be there, perhaps because they are particularly
interested in receiving the intervention. The evaluations supporting promising programs
must also yield statistically significant results that can be attributed with reasonable
confidence to the program, and not some other factor (like selection bias, or history

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for Your School
 effects – that’s when something else is going on, like another prevention program, which
could serve as an alternate explanation of the study’s results). There must also not be any
evidence of harmful effects – which cannot be taken for granted.
Promising programs must also be ready for dissemination and supported by curriculum
manuals, training (which may be in person or web-based), and technical assistance, so
that they can be implemented with fidelity. As stated earlier, for Blueprints for Healthy
Youth Development, “model” programs have to reach higher standards of effectiveness,
supported by evidence either from two RCTs or one RCT supported by one quasi-
experimental evaluation. In addition, the positive effects of the program must be noted
for at least 12 months following program completion. This is a particularly challenging
criterion, insofar as any positive effects noted immediately following program completion
– within a few days or weeks of the end of the program – typically decay quickly, and
disappear entirely within a year. Thus only a very few programs can satisfy this key criterion.
Two of them, which we will be examined in some detail, are Project Towards No Drug
Abuse and LifeSkills Training.
Searching capabilities. One of the advantages of registries like Blueprints is that you
can search for the programs that constitute the best fit for your population of interest.
Blueprints, for example, allows the user to search on a number of terms, such as behavior
whether your interest is in tobacco, alcohol, or illicit drugs or specific program objectives
such as refusal skills and low school attachment. The programs that appear following each
search have demonstrated effects on the behavior or program objective specified. Hence
you can look for programs that have had particular effects on tobacco, alcohol, or illicit
drugs, depending on the needs of your particular school. You can also search on specific
program objectives, and discover which programs have targeted those objectives and
have reported significant effects. You can also search the database in regards to student
populations that are of interest to your district or school.
As was stressed throughout this course, programs that were developed for and found
effective with specific populations as defined by developmental age should be used only
for those populations. Some programs have been developed specifically for one gender
or the other. Some have also been developed for and tested with a particular race or
ethnicity, and have gone through a process to ensure that they are culturally appropriate.
You can also search on whether you want a program that targets a universal, selective, or
indicated population – depending on the level of risk of the students in the school. We
have been focusing primarily on universal prevention programs that target all students,
but you may work with schools where students are either at very high risk for substance
use or have already begun to use. Selective or indicated programs would then be more
appropriate for these schools. Matching these search criteria to your school’s or students’
needs can be challenging without fairly recent school survey that includes questions that
match all these constructs. But it is likely that the school’s administration and teachers
have a fairly good idea of the nature, severity, and extent of particular problems that the
school faces, which can and should provide guidance to inform the selection process.

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Examples of ‘What Works’ in Prevention: School-Based Course
Module 6 overviews some examples of evidence-based prevention strategies beginning
with two school curricula and one program that alters the classroom climate: LifeSkills
Training (http://www.lifeskillstraining.com/), Project Towards No Drug Abuse (http://tnd.
usc.edu/), and the Good Behavior Game (www.air.org/topic/education/good-behavior-
game). The first two, LifeSkills Training and Project Toward No Drug Abuse, constitute
more traditional substance use prevention curricula that target students in their early and
later adolescence, respectively, and as such their various components may seem familiar
because these are found in many such curricula. The Good Behavior Game, which may
not be quite as familiar, is a classroom management program for young students.

LifeSkills Training
LifeSkills Training is one of the best known school-based substance use prevention
curricula available. It has now amassed an extensive and solid body of supportive
evidence that demonstrates its effects not only on substance use – including alcohol,
tobacco, and other substances – but also on crime, delinquency, and violence. One
of the important things we have learned in prevention research is that many of these
multiple youth behavior problems can be addressed with the same theoretically-based
intervention. This shouldn’t be surprising given that many of these behaviors have the
same root causes and etiology. As its name suggests, the purpose of this program is to
teach a variety of skills, including: Personal and social skills including decision-making
skills, goal setting skills, analytic skills to assess information on tobacco and alcohol and
violence for instance, skills to understand and resist pro-drug influences; intent not to use
substances; and refusal skills.
Structure and delivery. The course is designed to be taught in 15 sessions lasting about
45 minutes each. The course is taught by means of facilitated discussions, structured small
group activities, and scenarios in which student’s role play various scenarios in which they
can practice the life and social skills they have learned. Note that this course has been
evaluated and found to be effective both in regard to universal populations of middle
school students but also selective, high risk populations of students in alternative high
schools. In the United States, alternative high schools have been developed for students
at high risk of dropping out, or who cannot tolerate typical classroom environments. Note
also that the effects of LifeSkills Training have been tested in reference to students from
multiple racial and ethnic backgrounds. Indeed, most prevention curricula are remarkably
robust across students of differing race and ethnicity. Lessons include: Making decisions
independently; resisting group pressure, smoking/alcohol use/marijuana use: Myths
and realities; ability to analyze data; advertising to recognize fact from fiction’ coping
with anxiety through easy and healthy techniques; communicating effectively; social
skills to build relationships—e.g., listening; conversation; giving/receiving feedback;
and assertiveness. One of LifeSkill Training’s greatest assets is that it has now been
used in multiple countries worldwide, which provides some assurance that the program
transcends particular languages and cultures. Training is available for teachers; there is
also a certification process for teacher trainers, who help to sustain the program in areas
where it was widely adopted. Technical assistance is also available upon request, as well
as tools to assess teachers’ fidelity to the course guide. We will discuss the importance of

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 maintaining fidelity, and how to assess it, later in this module.

Project Towards No Drug Abuse

The second course that we will describe is Project Towards No Drug Abuse (Project
TND). The purpose of this course is to teach a number of skills, including self-control,
decision-making, and substance use resistance, and to strengthen motivations not to use
substances, which is another way of saying to increase anti-substance use attitudes. In
various program evaluations, this course has demonstrated effects not only on a variety of
substances but also the risk of victimization (e.g., bullying) and weapon-carrying as well.
Structure and delivery. Project TND, which uses interactive methods, is taught in 12
weekly sessions of about 40 minutes each, and is thus designed to fit comfortably within
a traditional 45-50 minute class period. While it has been tested on students from early
adolescence through young adulthood, it is designed primarily for universal and selective
populations of adolescents in school settings: Both regular and alternative schools. This
course is one of the relatively few that are available for adolescent populations. The lesson
topics included in the Project TND curriculum are: Communication skills, stereotyping,
myths and denial, chemical dependency, stress, health and goals, self-control, positive
and negative thought loops, perspectives, and making decisions. This course has mainly
been administered and evaluated in the U.S., so we have only a limited understanding
of how well it is suited for student populations elsewhere. The program comes with a
teacher manual that includes activities with clear guidelines and timeframes, to ensure
that it will fit into each 40 minute period designated. All sessions are linked to a student
workbook. Teachers new to the course are encouraged to attend aone or two day in-
person training. Pre- and post-test surveys are available to test for the program’s effects.
There is also a classroom observation form that is provided to assess the fidelity of
program implementation.

Fidelity vs. Adaptation

As most of the evidence-based prevention interventions or policies have been developed
in western countries, there may be a need to tailor the program for a non-western
community. However it is important to remember, particularly for evidence-based
interventions, to maintain the intent of the program by maintaining the full program. This
represents a balance between fidelity, the delivery of a prevention intervention program
as prescribed or designed by those who developed the program and adaptation, the
modification of program content to accommodate the needs of a specific consumer or
target group (Castro, 2004).
We now turn our attention to the implementation of substance use prevention programs
and the issue of fidelity vs. adaptation. Why is it important to be concerned about the
balance between the two? Here are some illustrative examples. Some of these are obvious,
like if the program is in English and delivered in English, a target group that doesn’t
speak English fluently will not understand the program content. But some changes are
not so obvious. For example, when the program was evaluated in a white or Western
population and the target group is not white or Western, there may be fundamental
differences in beliefs, values, and perhaps norms that affect how the program affects

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the targeted population. The developers of prevention programs always prefer that their
curricula be implemented exactly as intended, to achieve maximum effects and following
their interpretation of the theory on which the program is based. They are right to do so:
over time, studies have repeatedly shown that programs evaluated under conditions of
what are called efficacy – that is, closely overseen by the developer and implemented
by teachers who are both familiar with and enthusiastic about the course – almost always
generate stronger effects than those implemented by teachers under effectiveness
conditions – often new to the program and implementing it as just another part of their
job. Prevention Managers and Supervisors need to know the elements that go into making
an intervention effective. If coordinators recommend an evidence-based intervention, but
if it isn’t implemented with fidelity, then it could easily fail and set back both the program
and the students exposed to it.

Adaptation
Teachers often adapt prevention curricula by changing their structure, adding or omitting
content, or changing teaching strategies. In regard to structure, when teachers run out
of time, they may split lessons across periods, starting in one and finishing in another.
Or they may rush through a lesson in a class period and then try to teach as much as
they can of another. They may also teach lesson components, or entire lessons, out of
order. Just as often, teachers may omit content, often the introductions of summaries
that developers carefully construct to reinforce the primary points of the course. They
may also omit explanations of suggestions for homework provided by the course guide,
or fail to assign any homework. They may also omit content because they dislike (or are
uncomfortable with) some of the components, like videos – which may seem out of date
(e.g., the slang used). Teachers may know from experience that some components fail to
hold their students’ attention, or may be inappropriate for any of a number of reasons,
including a lack of fit with students’ developmental level or culture. These changes are
risky as curriculum specialists develop programs in a certain order with certain content so
that each successive component builds on the ones preceding it.
Is program adaptation a bad thing? Yes, the developers will tell you, it generally is.
Particularly if teachers delete or modify key content – which is sometimes called “core
components.” Unfortunately, what content is “core” and what is “peripheral” is a matter
of expert judgment – and even the experts will disagree among themselves. Adaptation
also tends to be a bad thing if teachers modify teaching strategies, especially by changing
interactive methods to didactic ones. Also problematic is introducing new ideas or
concepts that are not included in the course, if only because that is likely to take time
away that is required to teach the course itself. In general, developers and evaluators will
correctly tell you, program adaptation has been empirically linked – over and over again
– to failure to achieve program outcomes.
Can program adaptation ever be a good thing? Sometimes, although there is little research
to substantiate this. But it might make sense to adapt program components or content
to make them more culturally relevant or accessible. For example, is it appropriate to
show to poor inner city youth of color in a developing nation a video that features white
adolescents with cars in an obviously wealthy suburban setting in the United States? It may
also be appropriate to modify the content to make the program more culturally relevant

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 or accessible, perhaps by changing some of the language, symbols, or stories. There are
at least two other reasons to adapt programs. One is to increase the “ownership” and
understanding of the program by the teachers who will be implementing it. That is, if a small
group of professionals have painstakingly reviewed a course to ensure its appropriateness
for the population of students targeted, they are more likely to understand and engage
with it and to sustain its use over time. The other reason is to increase the likelihood that
students will be interested in the course by deleting or modifying content that is likely to
alienate or bore them, or otherwise lose their attention.

Monitoring Fidelity
Now we will talk about measuring teacher fidelity to program implementation. There are
two general approaches to this task: Teachers’ self-reports of fidelity and Observer
ratings by trained specialists who observe a lesson from the back of the classroom.
Teachers’ self-reports are much more common, but are less reliable insofar as they may
be biased, especially if the teachers think that their level of fidelity will contribute to their
overall performance ratings. It is hardly surprising, then, that teachers typically rate their
program fidelity as higher than that of observers. Observers’ ratings are usually more
objective, and they are in a better position to determine if the teacher managed the
classroom effectively, praised students appropriately, were accepting of students’ ideas
and contributions, and repeated questions as appropriate, following up with probes as
needed. However, observers are costly, so they are not used frequently; neither are video
cameras, which are an inadequate replacement for observers because they typically only
capture a partial view of the class. Yet self-administered teacher checklists of fidelity are
probably worthwhile, if they emphasize to the teacher the importance that the school
administration places on maintaining course fidelity.

Adapting a Program
There is a fair amount of advice in the literature as to how to adapt a prevention program,
but there is no clear recipe as to how best to proceed. Clearly, the place to start the
adaptation process is with an evidence-based course. If it is not evidence-based, there’s
no reason to believe that you can make it so by adapting it. It would be quite easy, on
the other hand, to damage the course’s effectiveness by going too far in the adaptation
process. Now, what is there about a program that might suggest the need for adaptation?
Here are some issues to consider.
„ Is the language accessible to the students for whom the course is intended? Are
there words used that they might not understand? Are their colloquial expressions,
particularly for substances mentioned, that would be better than those specified in
the course?
„ Are there pictures, graphics, symbols, or videos that seem inappropriate or out of
date? For instance, one course used a picture of a mailbox on an American Indian
reservation that had no mailboxes because all mail was delivered to post office boxes.
Another used out-of-date videos with pictures of white middle-class students for an
audience of African-American children.
„ Some concepts may be particularly challenging. For example, it may not be appropriate
to show a picture or video of a female in shorts or a sleeveless blouse in some societies,

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 or of a female talking to a male if she is not accompanied by a family member.
It would be helpful to create an initial list of the various items in the course that are
candidates for adaptation. With that list, the next step is to review the literature concerning
evaluations of the prevention course, paying particular attention to the effects of the
course on the mediating factors that the program addresses, such as, decision-making,
assertiveness, refusal skills, and so on. Then identify the core components that appear to
be most closely related to these factors. For example, if a course clearly reduced students’
perceptions of the extent of substance use by their peers – that is, if the course had a
lesson with activities targeting perceived normative behavior – then that core component
would be particularly important to preserve in as intact a form as possible. Also important
to preserve are the instructional (or teaching) strategies associated with the core
component. For instance, it would be difficult to imagine an activity that would be more
effective if delivered by way of a lecture or through an unstructured class discussion than
by means of small group work or role plays. Regardless, the outcome of this process
should be an informed judgment as to what can be changed, and what should be left
alone because the risks of changing it are too great.
Here are some pointers from the U.S. Substance Abuse and Mental Health Services
Administration about adapting a program for a new community.
1. Change capacity before changing the program. It may be easier to change the
program, but changing local capacity to deliver it as it was designed is a much safer
choice. Developer-sponsored training concerning the delivery of the program may
be an expensive and time-consuming option – often requiring a day or two – but it is
likely to pay off in terms of ensuring the effects of the course.
2. Consult with the program developer to determine what experience and/or advice
he or she has about adapting the program to a particular setting or circumstance.
Many developers appreciate being contacted by the users of their curricula, and will
respond to your questions. Their email addresses are not difficult to find, and are
available on the NREPP website under “contact information.”
3. Retain core components since there is a greater likelihood of effectiveness when
a program retains the core component(s) of the original intervention. That said, it
sometimes difficult to determine what is, and is not, a “core component.” Again,
developers may be helpful to you in making this decision, or they may simply advise
you to administer the entire curriculum as specified. Be consistent with evidence-
based principles. There is a greater likelihood of success if an adaptation does not
violate an established evidence-based prevention principle.
4. Add, rather than subtract from the program. It is safer to add to a program than to
modify or subtract from it. But adding is still risky, because adding the wrong material
may detract from program effects. For example, bringing a chart to school showing
what controlled substances look like in pill form may simply teach students to be better
consumers. Or, for another example, teachers who answer students’ questions honestly
about substances they have used – like alcohol and tobacco - may reinforce students’
impressions that they can use these substances without adverse consequences.

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for Your School
 Prevention Practitioners can lead discussions with their colleagues on when and how best
to adapt an evidence-based intervention to address local needs without losing its impact.

References
Blueprints for Healthy Youth Development. http://www.colorado.edu/cspv/blueprints/
Castro, FG, Barrera, Jr. M., and Martinez, Jr., CR. (2004). The cultural adaptation of
prevention interventions: Resolving tensions between fidelity and fit. Prevention Science,
5: 41-45.
Evidence Based Practice Institute, 2012; http://depts.washington.edu/ebpi/.
Faggiano, F., Vigna-Taglianti, F. D., Versino, E., Zambon, A., Borraccino, A., & Lemma,
P. (2008). School-based prevention for illicit drugs use: A systematic review. Preventive
medicine, 46(5), 385-396.
Foxcroft, D. R., & Tsertsvadze, A. (2012). Cochrane Review: Universal school-based
prevention programs for alcohol misuse in young people. Evidence-Based Child Health:
A Cochrane Review Journal, 7 (2), 450-575.
Greenberg, M.T., et al. (2005). The study of implementation in school-based preventive
interventions: Theory, research, and practice. Promotion of Mental Health and Prevention
of Mental and Behavioral Disorders 2005 Series V3.
LifeSkills Training (http://www.lifeskillstraining.com/
Project Towards No Drug Abuse (http://tnd.usc.edu/)
Sloboda, Z., et al. (2014). Implementation Science and the Effective Delivery of Evidence-
Based Prevention. In Defining Prevention Science (pp. 293-314). Springer US.
Thomas, R., & Perera, R. (2006). School-based programmes for preventing smoking.
Cochrane Database Syst Rev, 3.
United Nations Office on Drugs and Crime. (2013). International Standard on Drug Use
Prevention. Vienna, Austria: UNODC. Available at: http://www.unodc.org/unodc/en/
prevention/prevention-standards.html
U.S. National Institute on Drug Abuse. Preventing Drug Use among Children and
Adolescents. http://www.drugabuse.gov/sites/default/files/preventingdrug use_2.pdf
U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) National
Registry of Evidence-based Programs and Practices (NREPP). http://nrepp.samhsa.gov/
Wandersman, A., et al. (2008). Bridging the gap between prevention research and practice:
The interactive systems framework for dissemination and implementation. American
journal of community psychology, 41(3-4), 171-181.

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 MODULE 7
SCHOOL ENVIRONMENT AND SCHOOL POLICIES

Content and timeline .....................................................................................318

Training goals and learning objectives .........................................................318
Introduction to module 7 ...............................................................................319
PowerPoint slides ...........................................................................................320
Resource Page ................................................................................................344
Summary..........................................................................................................345

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Participant Manual: Module 7—School Environment and School Policies
 Content and Timeline
Person
Activity Time
Responsible
Introduction to Module 7 15 minutes
Presentation: The school environment and
20 minutes
environment programs
Presentation and discussion: Examples of ‘what works’
20 minutes
in prevention: Good Behavior Game
Break 15 minutes
Presentation: School policies: Introduction 5 minutes
Small-group exercise: Why implement school policies 60 minutes
Presentation and discussion: Objectives of school
20 minutes
policies/violations
Presentation: School tobacco and alcohol policies 20 minutes
Presentation and discussion: Drafting a school policy 30 minutes
Lunch 60 minutes
Small-group exercise: Drafting school policies 45 minutes
Reflections 10 minutes
Module 7 evaluation 15 minutes
Break 15 minutes
Total Time = 350 minutes (5 hours 50 minutes)

Module 7 Objectives
Learning objectives
Participants who complete Module 7 will be able to:
„ Describe the key principles of school and classroom environmental improvement
programs;
„ Draft a model alcohol and tobacco prevention policy for schools; and
„ Draft a model policy related to students found to be using substances for schools.

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Managers and Supervisors Course 05: School-based Prevention Interventions
Introduction to Module 7
The nature of the school environment is very important because the interactions between
children and the environment can shape their values, beliefs, attitudes, and behavior, and
are particularly important to physical, emotional, and social development from childhood
to adolescence and then to adulthood. All of these interactions can also affect risk to
substance use.
There are a number of programs designed to improvement the school environment. These
tend to: Support an orderly school climate and normal functioning; enhance teachers’
ability to management their classrooms effectively; socialize children in their roles as
students; and reduce disruptive and aggressive behaviors. They also include specific
strategies designed to: Reward appropriate, prosocial behaviors; respond effectively to
inappropriate behaviors; actively engage all students; strengthen students’ attendance
at school and bonds to their school; and support academic achievement. An addition to
improving the school environment is to enhance the classroom environment. The Good
Behavior Game intervention is presented as an example.
Another approach to addressing the school and classroom environment is through
reasonable and appropriate school policies. School policies related to substance use are
an integral and vital part of the school’s comprehensive substance use prevention program
because they help to promote social norms that substance use will not be tolerated.
School policies will also reduce students’ exposure to people smoking or drinking who
may serve as negative role models. And, these policies can also act as a deterrent to
substance use and possession.
You will also review the structure and development of policies; and the elements involved
in a tobacco control policy example which has been found to be effective. Then, you will
consider some of the issues involved in drafting policies for substance use and some of the
difficulties you might encounter. Particularly important are issues in regard to violations of
the policy and penalties involved; and the counseling and treatment services offered to
help students who have experienced substance use problems.

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 The Colombo Plan Drug Advisory Programme (DAP) Training Series
Universal Prevention Curriculum for Substance Use (UPC) Managers and Supervisors Series

Managers and Supervisors

Course 05
School-Based Prevention
Interventions

MODULE 7—SCHOOL ENVIRONMENT

AND SCHOOL POLICIES



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 The School Environment



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 An Interaction of Personal Characteristics and the
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Participant Manual: Module 7—School Environment and School Policies
 Resource Page 7.1: Drafting a School Policy

„ Form a policy working group.

„ Review existing policy.
• What should be deleted or modified?
• What should be added?
„ Ensure that the policy specifies the:
• Substances to be targeted;
• Locations that the policy will cover (School campus only? All locations where school
events are held?); and
• Categories of individuals to whom the policy applies (Students only? Teachers and
staff? Visitors?).
„ Draft revised or new policy.
„ Consult all key stakeholders, including superintendent or principal, other administrative
staff, teachers, parents and students.
„ Develop final policy.
„ Disseminate final policy (including teacher and staff training).
„ Review and disseminate policy every few years.

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Managers and Supervisors Course 05: School-based Prevention Interventions
Summary of Module 7: School Environment and School
Policies
The School Environment
The nature of the school environment is very important because the interactions between
children and the environment can shape their values, beliefs, attitudes, and behavior,
and are particularly important to physical, emotional, and social development from
childhood to adolescence and then to adulthood. All of these interactions can also affect
risk to substance use. Effective school interventions and policies, then, can constitute a
major influence that can positively affect an individual’s vulnerability and risk to problem
behaviors in general, and substance use in particular.
A positive school environment is essential to the success of any school-wide substance use
prevention effort. The school environment encompasses a number of features, including:
Its culture and social norms governing appropriate prosocial behavior; a strong sense of
community so that students feel that they support and belong to an institution that they
admire and are proud to be a part of; shared expectations so that everyone knows what
they should do; a common understanding of the school’s mission and goals, and a sense
of order, fair play, and appropriate accountability and discipline for violations of rules.

Environment Improvement Programs

There are a number of school-wide programs that are designed to enhance the quality of
school environments (Campello, et al., 2014; UNODC, 2013). These tend to: Support an
orderly school climate and normal functioning; enhance teachers’ ability to management
their classrooms effectively; socialize children in their roles as students; and reduce
disruptive and aggressive behaviors. They also include specific strategies designed to:
Reward appropriate, prosocial behaviors; respond effectively to inappropriate behaviors;
actively engage all students; strengthen students’ attendance at school and bonds to
their school; and support academic achievement.

Example of ‘What Works’ in Prevention: Classroom

Environment
Good Behavior Game
The Good Behavior Game is a classroom environment improvement program that
Blueprints for Healthy Youth Development specifies as “promising,” insofar as it only
meets minimum standards of evidence. Typically classroom environment improvement
programs are delivered in early years of school when children are around 6 to 9 years old.
They include strategies to respond to and correct inappropriate behavior in the classroom
setting, and to acknowledge and reward appropriate behavior.
Structure and delivery. Like all evidence-based programs that are delivered in classroom
settings, the course actively engages students. The Good Behavior Game requires
teacher training to ensure that it is administered correctly. In particular, the program seeks
to reduce aggressive or otherwise disruptive classroom behavior by: Establishing a set

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Participant Manual: Module 7—School Environment and School Policies
 of rules of appropriate conduct, teaching students how to behave and work together
effectively as members of a team, and showing students how to monitor their own as
well as their team’s behavior. The teacher also specifies incentives for positive behavior
for both the individual student and the team as a whole. Evaluations have demonstrated
that the program reduces substance use and violence, and enhances students’ mental
health. Teachers assign all children in the class to one of three teams. In so doing, the
teachers must be careful to distribute children that they believe may have the potential
to be aggressive or disruptive evenly across the teams, so that they cannot dominate any
one of them. Teachers should also evenly distribute shy and socially isolated students
across the teams, so that the overall characteristics of the students in each team are well-
balanced.
For the first three weeks, the Good Behavior Game is played three times a week for
a period of ten minutes each game at announced times. Following that period, both
the length and frequency of the game increase until it is played daily by the middle of
the school year, at unannounced times that vary from one day to the next. The whole
team receives an immediate award if the members of the team commit less than five
infractions (that is, breaking the rules) during each game period. During the year, the
length and frequency of games are increased, but rewards are increasingly unpredictable
and infrequent, and then given at the end of the school day, or week.

School Policies
Another approach to addressing the school and classroom environment is through
reasonable and appropriate school policies. School policies related to substance use are
an integral and vital part of the school’s comprehensive substance use prevention program.
Unfortunately, they are all too often developed in a casual and unsystematic manner
and then buried in the school’s manual of policies. Policies are particularly important
for at last three reasons. First, policies restricting the use of substances help establish
social norms that substance use will not be tolerated. If students see that no smoking or
drinking whatsoever will be tolerated on school grounds, or at school-sponsored events,
their exposure to potential role models who are exhibiting the behavior will decrease.
As such, their normative beliefs that substance use is inappropriate should strengthen.
To reference the model of the determinants of behavior yet again, policies can also be
conceptualized as acting like environmental constraints, insofar as they can reduce access
to substances. Third, policies can also act as a deterrent to substance use and possession.

Structure
The structure of substance use school policies often includes a statement of purpose,
which might include language referencing the need to establish and maintain a safe,
healthy, and substance use-free environment to support the healthy development of
all students and to ensure that they achieve their academic potential. Many policies
also commit the school to implementing programs and policies that represent known
principles of effectiveness, and, where possible, are supported by evidence. The “where
possible” is probably necessary as a qualifier, since schools may be unable to secure the
prevention curricula with the strongest foundation of evidence, and the empirical base for
the effectiveness of school-based policies is still emerging. But the goal of this course is

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Managers and Supervisors Course 05: School-based Prevention Interventions
to encourage the use of evidence-based programs and policies which have the greatest
potential for being effective. One of the most important objectives in school policy is to
ensure that the policy is communicated to everyone in the school community who would
be affected. Who would be covered by the policies—students, staff, visitors? Does it only
apply to campus life? What about school-sanctioned activities? All of that needs to be
considered and communicated widely to everyone.
Policy coverage and violations. Policies should also specify the range and types of
substances they include – for example, how will the school respond to the growing
popularity of e-cigarettes? - and cover substance use and possession not only at school
but also at school-sponsored events. Perhaps the most problematic of these are athletic
games, which may have a history and culture of alcohol use that is particularly hard to
eradicate. In addition, the policy should include the use of substances on school grounds
and at events by teachers and staff as well as students. Again, these might generate
considerable resistance in countries where tobacco use is normative. The policy should
also make clear what types of substance-related incidents will be sanctioned – for
example, the possession or sale of various types of substances, or a reasonable suspicion
that a student has come to school impaired. Policies should also be clear about whom,
and at what point in the process, families and law enforcement authorities will be notified
concerning an event related to use, possession, and sales. These policies should also
specify clear consequences for violations by students that will be consistently enforced.
Policies should be readily available to, and understood by, all members of the school
community. These policies should not be punitive in nature but instead have the goal of
keeping students who use substances in school.
Students who need counseling or treatment. Generally speaking, students using
substances should be given the opportunity to stop using in a supportive environment
in which their behaviors – including timely attendance, the completion of homework
assignments, and academic performance – are closely monitored. Many schools have
established teams of faculty and staff that meet regularly with these students to review
their progress. Students with substance use problems should also be referred for
counseling or substance use treatment, as appropriate. It is also critical that all members
of the school community, including students and their families, be aware of the school’s
substance use policies, including how the school will respond to violations. A school’s call
or note to a student’s parents, informing them that their son or daughter is involved with
substances, can be particularly challenging.

School Tobacco Control Policy Example

While there is great variability in policies, there are typical elements, or components,
of a model school policy. But it is unlikely that many policies would contain all of these
elements. In most cases, schools or districts pick those that seem most appropriate for
a given context. Some of the typical questions asked in regard to smoking for example
might include the following: If a policy will ban smoking on school grounds, will it include
staff and teachers as well as students? When students (or staff) are caught smoking or
in possession of tobacco products (including, perhaps, e-cigarettes), what will be the
penalties or sanctions? Will they be consistently enforced, or will there be exceptions
made and (if so), for whom and under what circumstances? And how will the policy be

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Participant Manual: Module 7—School Environment and School Policies
 communicated to staff and students to ensure widespread understanding and continued
awareness?
Evidence of effectiveness. What do we know about policies that target students’ use of
tobacco products? A summary of the effects of these policies suggests that: Schools that
enforce their anti-tobacco policies have lower rates of cigarette use than schools that do
not; key to the success of anti-tobacco policies is how well and how consistently they are
enforced, not how many components they have; and the effects noted are stronger if
policies are not limited to school grounds and instead include school-sponsored events.
On the other hand, policies that include staff in smoking bans donot seem to make much
of a difference, nor do efforts to communicate policies to a wide audience. Further, most
of the evidence about the effects of tobacco policies is contradictory, weak, or otherwise
inconclusive. Much work remains to be done before we can say what works and under
what circumstances.

School Alcohol Control Policy Example

There is also limited evidence concerning the effectiveness of school-based alcohol
policies, which have been subjected to very few empirical studies. Not surprisingly,
students who believe school alcohol policies are unlikely to be enforced are more likely
to drink on school grounds. However, drinking behavior in general is not linked to the
harshness or severity of any penalties imposed. On the other hand, lower rates of binge
drinking have been associated with exposure to messages related to abstinence and
counseling available from teachers for students who violated alcohol policies (Evans-
Whipp, 2013).

Drafting School Policies

So how do you start developing a substance use control policy at a school or school
district? Best practices suggest that a good place to start is by forming a policy working
group (UNODC, 2013). Who should it include? The choices are many, and will vary
from one school to another, but the group should probably comprise a representative
of the school’s or district’s administration, a teacher, and a counselor or school nurse.
But it also might include a student – particularly if the school has some form of student
government – and (perhaps) an interested parent. It may also be helpful to include a
member of local law enforcement to develop those components of the policy concerning
an appropriate legal response to violations. On the other hand, the group may decide
to keep itself relatively small to increase its efficiency, consulting with key stakeholders
or representatives as it moves forward. If the school or district has an existing policy it
should be carefully reviewed by the working group, because it may be out of date. Make
sure that the policy specifies all the substances that are to be targeted – in areas where
smoking is normative, tobacco may not be considered a drug. The policy should also
specify the locations to which the policy pertains – just the school campus? Or all venues
where school-sponsored events, including athletic events, are held? Finally, to whom will
the policy apply? Students only, or faculty, staff, and visitors as well? Or will some policies,
like those targeting smoking, apply only to students?

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Managers and Supervisors Course 05: School-based Prevention Interventions
Policy development or modification is likely to require some preliminary discussions,
especially if the board or members of the community are likely to think that a punitive
response to relatively minor violations of a substance policy – such as suspension,
expulsion, or referral to juvenile justice authorities for prosecution – may be appropriate.
By the same token, community members may be more tolerant of tobacco use – and even
alcohol use at sporting events – than the draft policy would allow. This may be a particularly
sensitive issue, as the principal or school master may receive calls from irate parents when
a star of the sports team is suspended because of alcohol use following a game. It is also
important to disseminate the policy widely throughout the community, perhaps within
the context of verbal or visual presentations that can address those components of the
policy that may be particularly likely to generate confusion or resistance. The potential for
a thoughtful discussion of the key provisions of and rationale for the policy will be much
greater if conducted prior to a violation. These policies should be formally reviewed every
3-5 years to determine how they have worked, what their consequences have been, and
if they need to be modified. It is also critical to ensure that these policies are effectively
disseminated to the entire school community on an ongoing basis.
There are also multiple considerations related to coming up with an inclusive policy to
deal with substance use incidents (UNODC, 2013). In this, there is little guidance as to
what could be considered “evidence-based practice.” So, until there is – you’ll have to
do the best you can. These policies are never easy to develop, especially if the school
operates under a mandate of “zero tolerance”. It may be helpful to start with a discussion
of what constitutes a substance use incident: For example, the consumption, possession,
or sales of substances. Then it gets more difficult, what about students who come to
school and appear to be under the influence? Or those who are rumored to be using?
Violations. One very important issue is to try to divide potential types of violations related
to substance use, possession, and sales into those that can be handled in an exclusively
non-punitive manner, and those for which some kind of sanctions – whether imposed by
the school (like dismissal from an academic team, or suspension or expulsion) may be
appropriate.
Another relates to when and how families of these youth may be contacted – by letter?
Telephone? Perhaps an invitation to the principal’s office – and how the youth will be
involved in these contacts. Some violations (such as sales) may be of such a nature that law
enforcement will have to become involved. In that case, protocols for how law enforcement
will behave – particularly when they are on school grounds – may be appropriate.
Counseling and treatment services. It is important to understand what kinds of
counseling and treatment services are available either in the school, the school district,
or in the community, and whether the services that are available are commensurate
with the need. So a number of questions should be addressed: What is the nature and
extent of the need for counseling and treatment services that the school currently faces,
or is likely to face? What resources – including professionals with appropriate expertise
and credentials - are currently available in the school, district, or community? Are they
sufficient to meet the need? Where resources are unavailable within the school, would it
be appropriate to develop memoranda of understanding concerning potential referrals
to community-based professionals? What capabilities does the school have, or should

349
Participant Manual: Module 7—School Environment and School Policies
 it have, to support students who are undergoing treatment? What kind of monitoring
of behavior (e.g., school attendance, timeliness, completion of homework assignments,
periodic drug testing) might be appropriate? What incentives and rewards can be offered
students whose level of compliance is high?

References
Adams, M.L., et al. (2009). The Relationship Between School Policies and Youth Tobacco
Use. Journal of School Health, 79(1), 17-23.
Campello, G., Sloboda, Z., Heikkil, H., Brotherhood, A. (2014). International standards on
drug use prevention: the future of drug use prevention world-wide. International Journal
of Prevention and Treatment of Substance Use Disorders, 1, 6-27.
Evans-Whipp, T. et al. (2004). A review of school drug policies and their impact on youth
substance use. Health promotion international, 19(2), 227-234.
Evans-Whipp, T.J. et al. (2013). The impact of school alcohol policy on student drinking.
Health education research, 28, 651-662.
Galanti, M.R. et al. (2013). Anti-tobacco policy in schools: upcoming preventive
strategy or prevention myth? A review of 31 studies. Tobacco control. doi:10.1136/
tobaccocontrol-2012-050846.
United Nations Office on Drugs and Crime. (2013). International Standard on Drug Use
Prevention. Vienna, Austria: UNODC. Available at: http://www.unodc.org/unodc/en/
prevention/prevention-standards.html .

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Managers and Supervisors Course 05: School-based Prevention Interventions
 MODULE 8
MONITORING AND EVALUATING SCHOOL-BASED
PREVENTION INTERVENTIONS

Content and timeline .....................................................................................352

Training goals and learning objectives .........................................................352
Introduction to module 8 ...............................................................................353
PowerPoint slides ...........................................................................................354
Summary..........................................................................................................377

Participant Manual: Module 8—Monitoring and Evaluating School-based Prevention 351

Interventions
 Content and Timeline
Person
Activity Time
Responsible
Introduction to Module 8 15 minutes
Presentation: Why do an evaluation? 10 minutes
Presentation: Evaluation review 20 minutes
Presentation and discussion: Example: LifeSkills
20 minutes
Training (LST)
Small-group exercise: LST monitoring 30 minutes
Presentation and discussion: LST outcomes 10 minutes
Small-group exercise: LST outcomes 30 minutes
Presentation: Evaluations of school/class environment
10 minutes
interventions
Summary and reflections 15 minutes
Wrap-up and Module 8 evaluation 15 minutes
End of Day 5
Total Time = 175 minutes (2 hours 55 minutes)

Module 8 Objectives
Learning objectives
Participants who complete Module 8 will be able to:
„ Describe the purposes of monitoring and evaluation for school-based prevention
interventions;
„ Illustrate some of the kinds of information that are useful in monitoring a school-based
prevention interventions: Curriculum, environment/climate, and/or policies; and
„ Describe at least two designs used to evaluate school-based prevention interventions.

352
Managers and Supervisors Course 05: School-based Prevention Interventions
Introduction to Module 8
This course has provided an overview of the initial stages of planning and implementing
an evidence-based prevention intervention in your schools. Earlier modules have covered
the assessment of the substance use problem in your area/country; the coordination and
implementation of planning efforts; and the selection and adaptation of the interventions
and policies for your schools. This module will build on these earlier modules and Course 3
on Monitoring and Evaluation to focus on the importance of evaluation in demonstrating
what you are doing in your prevention efforts and how you are progressing towards your
substance use prevention goals.
It will review definitions of terms including process evaluation/monitoring; outcome
evaluation, including short-, intermediate-, and long-term outcomes; and impact
evaluation. It will recognize the value of process evaluation to document what you did
even if you do not undertake outcome evaluation. You will revisit logic models as a
reminder of how to map the potential outcomes of your intervention. You will also briefly
revisit the evaluations for LifeSkills Training and the Good Behavior Game as examples for
conducting such evaluations.

Participant Manual: Module 8—Monitoring and Evaluating School-based Prevention 353

Interventions
 The Colombo Plan Drug Advisory Programme (DAP) Training Series
Universal Prevention Curriculum for Substance Use (UPC) Managers and Supervisors Series

Managers and Supervisors

Course 05
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Managers and Supervisors Course 05: School-based Prevention Interventions
Summary of Module 8: Monitoring and Evaluating
School-Based Prevention Interventions
Introduction
Since most of the evaluation studies that have been reported in the published and
unpublished literature have been focused on school-based prevention interventions, and
most of these on school curricula, the importance of monitoring and evaluation has been
the emphasis throughout this course. This module used some of the components of the
evaluation of LifeSkills Training and the Good Behavior Game to demonstrate how one
can assess school-based prevention efforts.

Why Do An Evaluation?
This module looks at the pros and cons of doing evaluations once more. Everyone who is
concerned about a problem like substance use may want to implement an intervention,
even an evidence-based intervention. They may be willing to spend the funds to pay
for the intervention but they don’t always see how the additional cost for evaluation
in money, human resources, and time is worth it. But as a Prevention Coordinator you
know that when you make the case for prevention you, always need to make the case for
monitoring and evaluation.
As was said earlier all of the effectiveness research in school-based prevention has been
rigorously evaluated for many years and has shown that the basic ingredients of the
intervention work to arm young people with attitudes, intentions, and behaviors that help
them make good decisions to avoid the risk of substance use and related behaviors. So,
if these programs are implemented, the assumption is that they can work, but will they
work in your community, with your populations, in your school setting, with your children?
The only way to know that is to evaluate. You need to have baseline information about the
students before you start—their attitudes and behaviors before they’re exposed to offers/
opportunities to use substances; you need to know whether teachers are delivering the
intervention in terms of its intended approach; you need to know whether you are making
progress toward your goals.
Also, monitoring and evaluation make good administrative sense for a number of reasons
including justification of costs in terms of manpower and other resources, assuring that
staff whether within your organization or other organizations are indeed delivering the
intervention as designed, and, to demonstrate to the community that participation in
prevention interventions is not harmful. Ultimately, monitoring demonstrates that the
intervention over time can help children to grow into healthy and productive adults. So,
evaluation is a tool that keeps you informed throughout the process; it’s not just an end
product of success or failure.
Of course, there are many challenges to conducting outcome evaluations, especially
those that use rigorous and expensive outcome designs. The key challenges are: Limited
funding and expertise available to you, shifting staff to conduct the evaluation may
interfere with ongoing activities; the sites where the interventions are to be implemented

Participant Manual: Module 8—Monitoring and Evaluating School-based Prevention 377

Interventions
 may not want to cooperate; and, some on your team may see that an evaluation has
limited value to the organization.

Evaluation Review
As a review, the following are the definitions associated with monitoring and evaluation
(Theodoulou and Kofinis, 2004).
Process evaluation or monitoring: The purpose of a process evaluation is to document
what takes place when an intervention or policy is implemented. It focuses on information
such as who was involved with the intervention or policy, what type of training was needed,
and what materials were used. This information is called ‘inputs’. In addition, information
as to who participated in the intervention, the duration of the intervention and specific
services received or other outputs of the program are the other component of process
evaluation.
But process evaluation is also more than just documenting the implementation of the
intervention or policy; it is a way of monitoring what is happening and when it happens.
Such monitoring assures that the intervention or policy is implemented as intended
not only according to a manual or guidelines but also according to the organization’s
prevention plan. This is a very important administrative tool for all service providers to use
if they wish to know and understand the programs that they are responsible for.
Outcome evaluation: The purpose of an outcome evaluation is to document and
characterize the extent to which knowledge, beliefs, attitudes, perceived social norms
and intentions to behave have changed from baseline or prior to the implementation of
the intervention, for those individuals or entities who received the intervention or who
were targeted by the policy as compared to non-recipients (often thought of as short-
and intermediate-outcomes).
Long-term outcomes relate to the desired end-product of the intervention, in this case,
the reduction or elimination of substance use behavior. Often evaluations end with long-
term outcomes.
Impact evaluation: The purpose of an impact evaluation is generally measured at the
community level, to determine the extent to which the objectives of a program or policy
are accomplished and whether any unintended effects could be identified. In many cases,
impact evaluation means--did the program have an impact on the initial problem at the
community level. But this would only apply if all of the students in a community had
been exposed to the program and you were measuring its impact several years later.
Because impact evaluations generally require long-term data collection efforts and can
be expensive, they are quite rare.

Evaluation Questions and Components

Process evaluation/monitoring. As described in Course 3, monitoring what is happening
in the delivery of a prevention intervention is not just a component of an evaluation; it is
also a good administrative tool. Process evaluation or monitoring asks the questions:
„ What did we do?

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Managers and Supervisors Course 05: School-based Prevention Interventions
„ How much did we do?
„ Who participated?
„ Who implemented the intervention/policy components?
„ Was the intervention/policy implemented as intended?
Outcome evaluation. Outcome evaluations are designed to tell us:
„ Did we achieve what we wanted to achieve with the intervention or policy? Do we see
a difference in attitudes, intentions, and behaviors from prior to the intervention?
„ Were our short-term outcomes met?
For example: As a result of the intervention do most students indicate that they intend not
to use drugs or other substances? As a result of a classroom management intervention,
did the children have improved reading scores?
Long-term outcomes. Long-term outcomes look at the effects of the program over an
extended period. These generally are outcomes measured 6 months to 1 year after the
completion of the intervention.
Although rare, some evaluations of prevention intervention programs look at outcomes
many years out. In many cases these long-term effects relate to the problem assessment
that was done initially. These may be effects at the community level. Did we have the
impact that we wanted? Did the program change the rates of new users of drugs and/or
other substances in our community—did the incidence of substance use go down? Did
we reduce drunk driving?
It may be years before prevention programming will have an effect on the outcome of
interest. We will see that when we review the experience of tobacco control and tobacco
use prevention in the curriculum on environmental interventions.
Monitoring and Evaluation System. A process evaluation is related to how the prevention
intervention is implemented and although an outcome evaluation focuses primarily on
outcomes, a full evaluation of a prevention intervention must include both program inputs
and outputs as well as short-, intermediate-, and long-term outcomes. If you learn from
an outcome evaluation that your program was effective, but you don’t know what you did,
or to (or for) whom, or how, what have you truly learned?
Please note that process evaluation or monitoring is very important EVEN WHEN
AN EVALUATION IS NOT PLANNED as it documents the delivery of the prevention
intervention. So if you are implementing any prevention program, you will want to monitor
what is going on in the program, who is being reached, and how much of the prevention
program was received.
The Logic Model for an intervention. The Monitoring and Evaluation Course described
logic models and how they work. The logic model includes such information as:
„ Goals: What is the substance use or related problem and how will it be addressed?
What is the long-term issue that is being targeted by the intervention?

Participant Manual: Module 8—Monitoring and Evaluating School-based Prevention 379

Interventions
 „ Intervening or predictor variable: These are the factors that the intervention is targeting
such as perceived consequences of substance use or normative beliefs about the
acceptability of substance use among children and adolescents.
„ Target population: Who would be eligible for the intervention? Parents? Adolescents?
„ Strategies: The following are the program activities/strategies (what, where, and how
much). This would define the intervention, where it would be implemented, and its
duration).
“IF-THEN” statements. These document short-term outcomes which are expected from
the intervention. These will lead to changes in these mediators, which in turn will lead to
the program goal.
„ Intermediate-term outcomes: The evaluation will document that these changes have
occurred IF…these intermediate-term outcomes vary from base-line.
„ Long-term outcomes: The evaluation will document reaching program goals IF...long-
term outcomes are achieved, such as reduced or non-use of alcohol, tobacco, or other
psychoactive substances.

Research Methodologies and Research Design

Course 3 on Monitoring and Evaluation described the various aspects of research
methods, including research designs, sampling issues, types of measurements, statistical
analyses, and finally, how to interpret and present the findings of a study. Course 3 and
Module 6 of this course provided an overview of the hierarchy of research designs used
to demonstrate effectiveness and to meet criteria for evidence-based interventions. The
most often cited acceptable design is the randomized controlled trial (RCT). Alternative
designs include the experimental design with a comparison group; the interrupted
times series experimental design, and the one group pretest and posttest design. The
advantages and disadvantages of each were discussed including the different situations
which require different approaches.

Example: LifeSkills Training

As mentioned earlier, LifeSkills Training is probably the most evaluated school-based
prevention intervention reported in the scientific literature. It has been evaluated in
18 groups of students over the past 30 years using randomized control trails. These
studies looked at both short-term and long-term effects up to 10 years past intervention
completeness. So, as an example, when the experimental group was 20 + years old,
they had a lower percentage of marijuana initiation and use than the control group.
These evaluations also addressed implementation fidelity and examined the relationship
between the mediators or short-term effects and the long-term outcomes of substance
use, risky sexual behaviors, and drunk driving.

Evaluations of School/Class-Room Environment and Policy

Interventions

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Managers and Supervisors Course 05: School-based Prevention Interventions
Conducting evaluations of school/classroom environment and policy interventions is
more challenging than course evaluations (Adams et al. 2009; Evans-Whipp et al., 2004;
Lovato et al. 2010). The challenges and facilitators that were discussed earlier apply to
these situations. But there is far less research available in this area. In general, studies
of school or class-room environmental interventions use randomized control trials or
experimental designs with matched comparison groups or some variation of these. They
also use school archival information.
Evaluation of school policies generally use school information on policies and violations
or school information on policies and school survey information that includes substance
use questions as well as using time series analysis of archival data.
The evaluation of the Good Behavior Game (Ialongo et al. 1999) included baseline data
collected before the intervention began, with a posttest annually through middle school,
and, finally, a 14-year follow-up. The long-term outcomes found reduced aggression and
substance use.
The GBG evaluation is more complex than that used for the evaluation of LifeSkills
Training. Perhaps this is because the intent of the Good Behavior Game is on socializing
children to their role as students.

References
Adams, M.L., et al. (2009). The relationship between school policies and youth tobacco
use. Journal of School Health, 79(1), 17-23.
Evans-Whipp, T., et al. (2004). A review of school drug policies and their impact on youth
substance use. Health promotion international, 19(2), 227-234.
Ialongo, N.S., Werthamer, L., Kellam, S.G., Brown, C.H., Wang, S., & Lin, Y. (1999). Proximal
impact of two first-grade preventive interventions on the early risk behaviors for later
substance abuse, depression, and antisocial behavior. American Journal of Community
Psychology, 275, 599-641.
Lovato C.Y., Pullman, A.W., Halpin, P., Zeisser, C., Nykiforuk, C.I.J., Best, F., et al. (2010).
The influence of school policies on smoking prevalence among students in grades 5-9,
Canada, 2004-2005. Preventing Chronic Disease, 7(6), 1-10. (http://www.cdc.gov/pcd/
issues/2010/nov/pdf/09_0199.pdf)
Theodoulou, S. Z. & Kofinis, C. (2004). The art of the game: Understanding American
public policy making. Belmont, CA: Wadsworth.

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Interventions
382
Managers and Supervisors Course 05: School-based Prevention Interventions
 MODULE 9
REVIEW OF SCHOOL-BASED PREVENTION INTERVENTIONS:
APPLICATION TO PRACTICE

Content and timeline .....................................................................................384

Training goals and learning objectives .........................................................384
PowerPoint slides ...........................................................................................385

Participant Manual: Module 9—Review of School-Based Prevention Interventions: 383

Application to Practice
 Content and Timeline
Person
Activity Time
Responsible
Introduction to Module 9 and review of exercise 15 minutes
Partner exercise: Development of a plan to organize
a school-based prevention intervention in your
60 minutes
community to integrate learning from this introductory
curriculum
BREAK 15 minutes
Large-group discussion: Review of plans, approaches
45 minutes
to overcoming barriers, and general Q & A session
Overall training evaluations 30 minutes
Program completion ceremony and socializing 30 minutes
End of Day 6
Total Time = 195 minutes (3 hours 15 minutes)

Module 9 Objectives
Learning objectives
Participants who complete Module 9 will be able to:
„ Develop a draft school-based prevention plan that will describe the steps needed to
implement evidence based prevention in their area; and

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Managers and Supervisors Course 05: School-based Prevention Interventions
 The Colombo Plan Drug Advisory Programme (DAP) Training Series
Universal Prevention Curriculum for Substance Use (UPC) Managers and Supervisors Series

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School-Based Prevention
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MODULE 9—REVIEW OF SCHOOL-BASED

PREVENTION INTERVENTIONS:
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Participant Manual: Module 9—Review of School-Based Prevention Interventions: 385

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Participant Manual: Module 9—Review of School-Based Prevention Interventions: 387

Application to Practice
388
Managers and Supervisors Course 05: School-based Prevention Interventions
APPENDIX A—LEARNER-CENTERED
TRAINER SKILLS
When delivering this course in a way that matches adult learning theory, trainers need to
know and use both “platform” skills and “facilitation” skills.

Platform Skills
Platform skills include how one presents, both verbally and visually.
Verbal platform skills for good trainers include the following:
„ Eliminate weak words/phrases, such as “sorta” and “later.”
„ Replace nonwords (like “um,” “ah,” and “er”) with pauses.
„ Use vivid language.
„ Use simple and direct language.
„ Emphasize beginnings and endings; transitions are important.
„ Project your voice so everyone can hear, but not too loud.
„ Vary vocal pitch and inflection for emphasis.
„ Vary vocal pace and rhythm to keep participants’ attention.
„ Use pauses for emphasis and to allow participants to think about what was just said.
„ Enunciate clearly.
„ Practice breath control for smooth delivery.
„ Be natural; loosen up (keep training serious, but also fun).
Visual platform skills include the following:
„ Stand up straight and confidently.
„ Move around the room to talk with all participants, but don’t move so much that it is
distracting.
„ If it is culturally-appropriate, use eye contact to keep participants’ attention.
„ Use hand gestures for emphasis, but not to the point of distraction.
„ Vary facial expressions for emphasis and to indicate your own interest.
„ Maintain a “match” between visual and verbal elements.

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Participant Manual: Appendices—Appendix A
 Facilitation Skills
Rather than simply provide information and give answers to questions, facilitating trainers
create a positive and productive environment that supports learning. The good facilitator:
„ Defines his or her role for participants;
„ Is positive;
„ Doesn’t judge;
„ Focuses participants’ energy on a task;
„ Suggests methods or procedures for accomplishing the task;
„ Protects individuals and their ideas from attack;
„ Helps find win/win solutions by seeking agreement on problems and process;
„ Gives everyone an opportunity to participate;
„ Resists the temptation to give immediate advice and offer solutions by redirecting
questions back to the group; and
„ Is not afraid to make mistakes.
Effective communication skills for facilitators include:
„ Listening with full focus on the speaker;
„ Focusing the training group’s attention;
„ Recognizing progress;
„ Scanning/observing;
„ Modeling;
„ Summarizing; and
„ Using silence appropriately.
The “ideal” facilitator was defined by Karger.1 Although he was writing about facilitating
marketing focus groups, his principles are apt for training facilitation as well. His definition
(with terms modified slightly) is as follows:
The best facilitator has unobtrusive chameleon-like qualities; gently draws group members
into the process; deftly encourages them to interact with one another for optimum synergy;
lets the dialogue flow naturally with a minimum of intervention; listens openly and deeply;
uses silence well; plays back group member statements in a distilling way that brings
out more refined thoughts or explanations; and remains completely nonauthoritarian and
nonjudgmental. Yet the facilitator will subtly guide the proceeding when necessary and
intervene to cope with various kinds of troublesome participants who may impair the
productive group process. (p. 54)

1 Karger, T. (1987). Focus groups are for focusing, and for little else. Marketing News, (21), 52–57.

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Managers and Supervisors Course 05: School-based Prevention Interventions
APPENDIX B—DEALING WITH DIFFICULT
PARTICIPANTS DURING TRAINING
During the course of training, you may encounter participants who display difficult or
challenging behavior. As the trainer, you have the responsibility of ensuring a comfortable
and safe environment for the other members of the group. Remember the following
points:
„ Project confidence and good humor.
„ Be prepared.
„ Don’t take it personally.
„ Use effective communication skills.
„ Avoid an authoritarian/lecturing approach.
„ Have clear guidelines for the group.
„ Avoid sarcasm.
„ Be patient and polite.
„ Redirect.
„ Assess whether you need to change your approach.
„ Ignore “bad” attitude.
You will encounter a range of learning styles across the group. If possible, try to establish
the expectations of the participants and incorporate different strategies to meet these
expectations in a range of ways to engage all learning styles.

Prevention and Early Interventions

„ Make the environment comfortable and the program interesting.
„ Explore participants’ motivations for being in the group.
„ Establish group rules and boundaries.
„ Involve participants in decision-making.
„ Establish a positive relationship and encourage relationships in the group—modeling.

Source: Government of Queensland, Australia, Brisbane North Institute of Technical and Further Education.

391
Participant Manual: Appendices—Appendix B
 „ Aim your intervention at the behavior and consequences, not at the person (the same
principle applies for groups and individuals).
„ The intention isn’t to apportion blame; it’s to resolve the problem.

Coping Strategies
„ Assess the situation—keep yourself and participants safe.
„ Ignore negative or non-damaging behavior.
„ Remain calm—don’t argue with the other person or make accusations; be discreet.
„ Avoid ultimatums.
„ Use active listening skills to check your understanding of the situation.
„ Refer back to group rules set up at the beginning of the session—what behavior will
or will not be accepted—and don’t get pushed beyond this limit.
„ Be persistent and consistent in your response, which conveys to the difficult person
that you mean what you say.
„ Provide an opportunity for time out or a private chat.
„ Believe in yourself and your ability to deal with others.
„ Look for ways to reduce the causes of the behavior.
„ Monitor the effectiveness of your coping strategy, modifying it where appropriate.
„ Assess the impact on others.
„ Seek advice if necessary.

Behavior Possible Reasons

What To Do
The participant is: The participant may be:
Overly talkative—to the „ An “eager beaver.” „ Interrupt with “That’s an
extent that others do not interesting point. Let’s
have an opportunity to „ Exceptionally well- see what everyone else
contribute. informed. thinks.”
„ Naturally wordy. „ Directly call on others.
„ Nervous. „ Suggest, “Let’s put
others to work.”
„ When the person stops
for a breath, thank him
or her, restate pertinent
points, and move on.

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Managers and Supervisors Course 05: School-based Prevention Interventions
 Behavior Possible Reasons
What To Do
The participant is: The participant may be:
Argumentative—to the „ Seriously upset about „ Keep your temper in
extent that others’ ideas or the issue under check.
opinions are rejected, or discussion.
others are treated unfairly. „ Try to find some merit
„ Upset by personal or in what’s being said;
job problems. get the group to see it,
too; then move on to
„ Intolerant of others. something else.
„ Lacking in empathy. „ Talk to the person
„ A negative thinker. privately and point out
what his or her actions
are doing to the rest of
the group.
„ Try to gain the person’s
cooperation.
„ Encourage the person
to concentrate on
positives, not negatives.
Engaging in side „ Talking about „ Direct a question to the
conversations with others in something related to person.
the group. the discussion.
„ Restate the last idea or
„ Discussing a personal suggestion expressed
matter. by the group, and ask
for the person’s opinion.
„ Uninterested in the
topic under discussion.
Unable to express himself „ Nervous, shy, excited. „ Rephrase, restating
or herself so that everyone what the person
understands. „ Not used to said and asking
participating in for confirmation of
discussions. accuracy.
„ Allow the person ample
time to express himself
or herself.
„ Help the person
along without being
condescending.

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Participant Manual: Appendices—Appendix B
 Behavior Possible Reasons
What To Do
The participant is: The participant may be:
Always seeking approval. „ Looking for advice. „ Avoid taking sides,
especially if the
„ Trying to get the trainer group will be unduly
to support his or her influenced by your point
point of view. of view.
„ Trying to put the trainer „ Show support without
on the spot. favoritism.
„ Having low self-esteem.
Bickering with another „ Carrying on an old „ Emphasize points
participant. grudge. of agreement and
minimize points of
„ Feeling very strongly disagreement.
about the issue.
„ Direct participants’
attention to the
objectives of the
session.
„ Mention time limits of
the session.
„ Ask participants to
shelve the issue for the
moment.
Uninvolved and unwilling to „ Lazy. „ Ask the person to
commit to new tasks. volunteer for tasks
„ Too busy already. (others in group must
„ Feel he or she should volunteer as well).
not have been made „ Clearly explain the
to attend the session in purpose of the training
the first place. and the benefits to
„ Unaware of his or her individuals and the
own skills and abilities. organization.
„ Identify how the
outcomes can
be applied in the
workplace.
„ Privately ask why the
person won’t become
involved and is unwilling
to commit to new tasks.
„ Provide constructive
feedback and provide
reassurance and
encouragement.
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Dealing with difficult behavior can be emotionally tiring. Caring for yourself during this
time is vital to the effective management of the situation:
„ Recognize the effect an interaction has on you.
„ Allow yourself recovery time.
„ Be aware of things that help you recover effectively and quickly.
„ Use your co-trainer for support.

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Participant Manual: Appendices—Appendix B
APPENDIX C—GLOSSARY
adaptation Modification of program content to accommodate
the needs of a specific consumer group.
amygdala Part of the brain in the temporal lobe that is associated
with memory and emotional reactions, and that
processes fear and impulsive reactions.
brief interventions Systematic, focused processes that aim to investigate
potential substance use and motivate individuals
to change their behavior. The goal is to reduce
risky substance use before the individual becomes
dependent or addicted.
cognitive skills The ability for people to think for themselves and
address problems in a reasoned way, conceptualize
and solve problems, and draw conclusions and come
up with solutions through analysis.
demand reduction Preventing or at least delaying youths’ substance use
by attempting to instill anti-substance use values,
norms, beliefs and attitudes, and by giving them the
skills to say “no” effectively to peers who may invite
them to use substances.
drug testing Chemical analysis of biological samples (including
blood, urine, hair, and sweat) to detect the presence
of drug or their metabolites.
demand reduction Preventing or at least delaying youths’ substance use
by attempting to instill anti-substance use values,
norms, beliefs and attitudes, and by giving them the
skills to say “no” effectively to peers who may invite
them to use substances.
effectiveness trials Tests whether interventions are effective under
“real-world” conditions or in “natural” settings.
Effectiveness trials may also establish for whom, and
under what conditions of delivery, the intervention is
effective.
efficacy Efficacy is the extent to which an intervention
(technology, treatment, procedure, service, or
program) does more good than harm when delivered
under optimal conditions.
evaluation A rigorous and independent assessment of either
completed or ongoing activities.

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Participant Manual: Appendices—Appendix C
 evidence-based practice Systematic decision-making processes or provision
of services which have been shown, through
available scientific evidence, to consistently improve
measurable client outcomes. Instead of tradition,
gut reaction or single observations as the basis of
decision making, EBP relies on data collected through
experimental research and accounts for individual
client characteristics and clinician expertise.
(Evidence Based Practice Institute, 2012; http://depts.
washington.edu/ebpi/)
executive functions Includes those areas of the brain involved in decision-
making, planning, awareness of time and skills, the
evaluation of new ideas, engagement with others,
and controlling impulsivity--areas most involved
in the perception of future consequences, social
interactions, and risky decisions leading to behavioral
problems.
intervention Focuses on altering trajectories by promoting positive
developmental outcomes and reducing negative
behaviors and outcomes.
intervention content The objectives of the intervention and has to do
with what information, skills, and strategies are used
to achieve the desired objectives. For example
inclusion of both peer refusal skills and social norm
development, inclusion of family communications
training.
intervention delivery How the intervention or policy is to be implemented
and how the intervention or policy is expected to be
received by the target audience. For example use of
interactive instructional strategies for adolescents
and adults, offering parenting skills programs at
times that are convenient for families, monitoring
the implementation of an intervention or policy to
enhance fidelity to the intervention’s core elements.
Intervention-fidelity The measure of how closely an intervention was
delivered compared to how delivery was originally
planned. Implementation quality is often quantified
with measures of fidelity, dose, quality of delivery,
and elements added to the intervention protocol.
intervention mediators The factors that the intervention intends to manipulate
and that are directly linked to the desired outcomes.
intervention structure How the prevention intervention or policy is organized
and constructed. For example the necessary number
of sessions or boosters; the organization of sessions.

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Intervention types Universal: For those who represent a mixture of user
groups, however most are non-users.
Selective: For those who are vulnerable or determined
to be at risk.
Indicated: For those who may have already initiated
substance use but do not need treatment.
macro-level environments Examples: social and physical environments/
neighborhood, economy, political environment,
social and natural disasters.
micro-level environments Examples: family, peers, school administrators,
religious leaders, workplace administrators and
colleagues.
monitoring The ongoing process by which stakeholders obtain
regular feedback on the progress being made
towards achieving their goals and objectives.
motivation, extrinsic Source for motivation comes from outside the person
and task, including expectation for reward, fear of
punishment, avoiding embarrassment.
motivation, intrinsic Source comes from within the person, like enjoyment,
or for its own sake.
personal characteristics Include: genetics, temperament, and physiology.
physical availability The extent to which drugs and alcohol are available
at work and can be used at work.
protective factors Characteristics that reduce the likelihood of substance
use.
risk factors Characteristics that interact with persona
vulnerabilities to increase the likelihood of substance
use.
socialization Lifelong process by which culturally appropriate and
acceptable attitudes, norms, beliefs, and behaviors
are transferred and internalized.
stages of change A theory that recognizes that individuals are at
different places on a continuum with respect to
making behavioral changes – typically from pre-
contemplation (where they do not consider their
current behavior to be problematic and have not
even begun to think about the change) through
contemplation, preparation, action, and maintenance
(where behavior change has been made and
sustained).

399
Participant Manual: Appendices—Appendix C
 stakeholder A person, group or organization that has interest or
concern in an organization affected by a course of
action.
stigma A set of negative and often unfair beliefs that a
society or group of people have about something;
disapproval of personal characteristics or beliefs
that are against cultural norms; stigma often leads
to status loss, discrimination, and exclusion from
meaningful participation in society.
supply reduction Developing reasonable, clear and consistently
enforced policies targeting the possession, use and
sale of all substances, including alcohol and tobacco,
on and around school grounds and at all school-
sponsored events.
vulnerability An individual disposition, determined by genetic,
psychological and social factors, that makes the
development of risk behaviors and mental disorders
more likely. The obverse is known as resistance
or resilience. (Lessons learned-vulnerable young
people and prevention – Federal Office of Public
Health, Bern, Switzerland, 2006:www.bag.admin.ch/
shop/00010/00207/index.html?lang=en

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APPENDIX D—RESOURCES
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APPENDIX E—CURRICULUM
DEVELOPERS
Zili Sloboda, Sc.D. Rebekah Hersch, Ph.D.
President Senior Research Scientist and Senior Vice
APSI, Ontario, Ohio President
ISA Associates
Susan B. David, M.P.H. Alexandria, Virginia
APSI
Bethesda, Maryland Richard Spoth, Ph.D.
F. Wendell Miller Senior Prevention
Chris Ringwalt, Ph.D. Scientist
Senior Evaluator Director of the Partnerships
University of North Carolina’s Injury Prevention Science Institute, Iowa State
Prevention Research Center University
Adjunct Professor Ames, Iowa
University of North Carolina School of
Public Health William Crano, Ph.D.
Chapel Hill, North Carolina Professor of Psychology
Claremont Graduate University
J. Douglas Coatsworth, Ph.D. Claremont, California
Professor of Human Development and
Family Studies
Colorado State University
Fort Collins, Colorado

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APPENDIX F—EXPERT ADVISORY
GROUP (2015 EDITION)
Thomas Browne Harry Sumnall, Ph.D.
CEO Colombo Plan Liverpool John Moore’s University
Liverpool, England, United Kingdom
Brian Morales
Branch Chief, Jeff Lee, M.Ed.
Office of Global Programs and Policies, ISSUP
Bureau of International Narcotics and Law Leicestershire, England, United Kingdom
Enforcement Affairs,
US Department of State Maria Paula Luna, M.A.
APSI
Felipe Castro, Ph.D. New York, New York, U.S.A
University of Texas at El Paso
El Paso, Texas, U.S.A Sue Thau, M.C.R.P.
Community Anti-Drug Coalitions of
Fernando Salazar, Ph.D. America
Universidad Peruana Cayetano Heredia Alexandria, Virginia, U.S.A.
Lima, Peru
Teresa Salvador
Giovanna Campello COPOLAD
Prevention, Treatment and Rehabilitation Madrid, Spain
Section, United Nations Office on Drugs
and Crime Tracy Tlumac, Ed.D.
Vienna, Austria The National Association of State Alcohol
and Drug Abuse Directors
Gregor Burkhart, M.D., M.P.H. Washington, D.C., U.S.A.
European Monitoring Centre on Drugs
and Drug Addiction Zachary Patterson, Ph.D.
Lisbon, Portugal Canadian Centre on Substance Abuse,
Ottawa, Ontario, Canada

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Managers and Supervisors Course 05: School-based Prevention Interventions
APPENDIX G—SPECIAL
ACKNOWLEDGMENTS
A special thank you to the following individuals who participated in pilot-testing the first
edition of this course in 2014 and created client case studies for the curriculum series.
Their input was invaluable.

Anthony Coetzer–Liversage Rogers Kasirye

South Africa Uganda

Dorji Tshering Susan Atieno Maua

Bhutan Kenya

Grace Duka-Pante Teresita Pineda

Philippines Philippines

Haji Yusof William Sinkele

Singapore USA

Little Jones Espeleta Susmita Banerjee

Philippines India

Maria Corazon Dumlao Josephine Choong Lean Keow

Philippines Project Manager - Curriculum
Development (Prevention), DAP
Naina Kala Gurung Sri Lanka
Bhutan
George Murimi Kariuki
Project Manager - Training , DAP
Rehana Kader
Sri Lanka
South Africa

Richard Gukunju
Kenya

,6683B

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