Implementing Interventions Effectively Between the Dream and the Reality of Prevention Linda Dusenbury, Ph.D. Tanglewood Research

Key Elements of Effective Programs Theoretically valid program content Comprehensive approaches Developmentally appropriate material Sensitivity to the culture and community Sufficient dosage and follow-up Use of interactive teaching techniques Well-trained implementers Continuing evaluation

Content of Effective Programs Norm Setting Social Resistance Skill Training Competence Enhancement

Norm Setting Establishing positive norms Correcting misperceptions about behavior Correcting misperceptions about attitudes

Social Resistance Skills Training Recognizing influences Developing cognitive techniques Developing peer resistance skills

Competence Enhancement Personal Skills  Decision Making  Stress Management  Goal Setting Social Skills  Communication Skills  General Social Skills  Assertiveness Skills

Ineffective Strategies Scare tactics and moralistic appeals Exclusive focus on information Exclusive focus on self-esteem Single shot assemblies Testimonials

Challenges to Effective Implementation Fidelity of Implementation Institutionalization

Effects of Fidelity on Smoking Source: Botvin,G.J., Baker,E., Dusenbury,L., Botvin,E.M., Diaz,T. (1995). JAMA, 273,

Effects of Fidelity on Alcohol Source: Botvin,G.J., Baker,E., Dusenbury,L., Botvin,E.M., Diaz,T. (1995). JAMA, 273,

Effects of Fidelity on Marijuana Source: Botvin,G.J., Baker,E., Dusenbury,L., Botvin,E.M., Diaz,T. (1995). JAMA, 273,

Professional Groups Interviewed Researchers Program Developers School Administrators Teachers Safe and Drug-Free Schools Coordinators

Factors Influencing Fidelity Program characteristics Organizational characteristics Characteristics of the provider Match between program and participants

Researchers’ Perceptions of Barriers to Effective Implementation Lack of Training Lack of Support Lack of Control Competing Demands Poor Match Between Program and Participants

Researchers’ Strategies for Improving Implementation Identifying essential content Detailed instruction manuals Methodology for assessing fidelity Communication Training Support

Program Developers’ Perceptions of Barriers to Effective Implementation Providers’ need to adapt programs Limited time and competing demands Program maintenance Hostile culture and lack of support Resistance by providers Lack of resources

Program Developers’ Strategies for Improving Implementation Detailed instruction manuals Strong message: Don’t adapt the material! Provider training Ongoing support and consultation

Other Considerations for Improving Implementation A program champion Choosing the right providers Flexibility

Administrators’ Strategies for Improving Implementation Training Support Measures to assess fidelity

Teachers’ Perceptions of Barriers to Effective Implementation Certain teaching strategies or activities Student resistance Limited time Miscellaneous difficulties Day-to-day crises

Teachers’ Strategies for Improving Implementation Creative adaptations Specific adjustments Infusing the program Training

Safe and Drug-Free Schools Coordinators’ Strategies for Improving Implementation Networking State coordination Program assessments and guides Training Experience Administrative leadership and support

Conclusions Strategies to Promote Fidelity Training and Detailed Instruction Communication Other Strategies