Enhancing School Prevention Partnerships by Micki Fuhrman, CPC, Regional School Health Coordinator When you are seriously hungry, which do you want to use to most quickly and efficiently get the food into your mouth? You need something that will do the job!

Who’s in the room? Name Role

Comprehensive Prevention: What comes to mind when you think of “Comprehensive”? What would be the opposite? What are the advantages and disadvantages fo each?

Adapted Health Belief Model Behaviors Knowledge Skills Self-Efficacy The most important predictors of current and future health status Adapted Health Belief Model Behaviors Abilities to act in healthy way Facts to make responsible decisions Understanding severity Risks and benefits Knowledge Skills Belief that one can use the skills to change life Self-Efficacy There are many theories of behavior change, such as the Social Cognitive Theory, Social Influence Theory, and Social Behavioral Theory. Michigan model has merged several theories into the Adapted Health Belief Model, which consists of 4 factors which contribute to behavior change: knowledge, skills, self-efficacy and environmental support. Behavior change is more likely to occur if these four factors are included. Knowledge: must have information such as risks, facts, related problems. Skills: person must understand practice and be able to use skills to promote the behavior. Self efficacy: person must believe he or she has the ability to succeed in changing behavior to impact their life Environmental support: The home, the school, peer group must support and encourage the newly changed behaviors for a person to use the knowledge and skills. Environmental Support Peers, school, home, community support and reinforcement for healthy behaviors

Environmental Support Typical Practice Behaviors Knowledge Skills Does knowledge always change behavior? Does it change YOUR behavior? What are some ways we give students “knowledge” alone? Self-Efficacy Environmental Support

Adapted Health Belief Model Behaviors Knowledge Skills Self-Efficacy Speaker talks about risks of using drugs Students know effects and consequences of use Comprehensive health curriculum with knowledge and skills No tobacco use No substance use Delay use of alcohol until 21 The most important predictors of current and future health status Behaviors Facts to make responsible decisions Understanding severity Risks and benefits Abilities to act in healthy way Refusal skills Communication skills (expressing what bothers you, I messages, problem solving and decision making Knowing and doing “3 D’s for telling” Comprehensive health curriculum Knowledge Skills Self-Efficacy School works with substance abuse coalitions for Safe Prom Students participate in “Most Teens Don’t” Social Norming project Schools promote substance abuse prevention with parents and families Parent resource sheets Healthy alternatives Schools have restorative policies for student caught using, and have referrals to assessment and treatment Belief that one can use the skills to change life Here are some examples of comprehensive prevention efforts. If our desired behavior is no tobacco or drug use, here are the supporting building blocks. Environmental Support Students’ social emotional knowledge & skills increase confidence Students empowered to say no with social norm training Peers, school, home, community support and reinforcement for healthy behaviors

Stop and Process What surprised you? What validated what you know? What are you wondering?

Be thinking about a prevention program you know about as we go through the discussion of “Effective” vs. “Ineffective” prevention strategies. See how it measures. Remember our goal is to never do harm.

Building on the Health Belief Model Think of it as a puzzle—what pieces do you need to add to make a complete and comprehensive puzzle? What works in Prevention? Remember, our goal is changing (or maintaining) behavior. How do we build skills, knowledge, self efficacy, and environmental support?

Effective prevention: Include parent/caregiver for family focus Enhance protective factors & reduce risk factors Provide continuity and repeated reinforcement Use interactive methods with trained teachers Target gateway drugs Promote refusal skills, anti-drug commitments, social competency Tailor age-specific, developmentally appropriate, & culturally sensitive programs Enhance school & family interventions with community campaigns and policy changes & address community drug problems Enhancing protective factors includes social skills to reduce early aggression, and increasing bonding to school, problem solving, academic support—reducing risk factors, such as

What doesn’t work and why? Affective only programs (self-esteem) Testimonies of ex-users Inconsistent messages (e.g. school has no use policy, but a beer tent fundraiser) One-Shot programs (e.g. assemblies) guest speakers Pre-packaged curricula used in isolation Non-promotion of students to the next grade Scare tactics, mild threats, dead days, crash cars Listing and describing a menu of drugs Information only programs about the negative effects of drugs

Coordinated School Health: Whole School, Whole Community, Whole Child

Coordinated School Health: Whole School, Whole Community, Whole Child

Stop and Process What surprised you? What validated what you know? What are you wondering?

For connection to the Regional School Health Coordinator in your area, please visit: https://mishca.org/

National Health Education Standards (NHES) 16

About Michigan Model Addresses Six CDC Risk factors Developed in the 80’s by a group of stakeholders On the NREPP list: Only comprehensive PreK-12th grade comprehensive health curriculum Proven effective at increasing attitudes against use of alcohol and tobacco and reduced intent to use alcohol and tobacco and in attitudes Results showed that students who received the Michigan Model for Health™ curriculum showed significant, positive changes compared to a randomized control group of students who did not receive the program. Specifically, students who received the Michigan Model for Health™ had: better interpersonal communication skills, social emotional skills, and self-management skills; improved pro-safety attitudes; stronger drug and tobacco refusal skills; less reported alcohol and tobacco use in the past 30 days; and enhanced knowledge and skills in physical activity and nutrition Health standards: core concepts, Analyzing influences, Accessing Information, Interpersonal communication, decision making and goal setting, self management, and advocacy

Michigan Model for Health™: Comprehensive Health for Pre-K through 12

UNIT K 1st 2nd 3rd 4th 5th 6th Alcohol, Tobacco, & Other Drugs How to safely use over-the-counter and prescription medicines Household products that can be dangerous Rules for avoiding poisons Trustworthy sources of information Illicit drugs Harmful chemicals in tobacco products Dangers of secondhand smoke and ways to avoid or reduce exposure Caffeine Staying away from nicotine and alcohol Saying “No” to secondhand smoke Medicines and poisons Negative effects of tobacco use Tobacco and media Alcohol and alcoholism Positive influences Refusal skills  Dangers of secondhand smoke and ways to avoid or reduce exposure Reasons individuals choose to drink or not to drink Decisions about alcohol and other drug use impact family and friends Family and friends influence alcohol and other drug use decisions Influence of advertising Dangers of inhalant use and how to avoid exposure Influence of family and peers on drug use Rules for safety around dangerous or unknown products Effects of smoking tobacco, secondhand smoke, and use of spit tobacco Advocate for someone to avoid tobacco use or quit using Analyze tobacco advertisements Effects of alcohol, especially on driving a vehicle Impact of alcohol and tobacco use on friends and family Ways to avoid riding with a driver who has been drinking and what to do if it can’t be avoided   Possible reasons people use or don’t use drugs Negative health effects of drug use Analysis of drug use data Persuasion skills for encouraging others to stay drug free Influence of family, society and peers on drug use Impact of drug use on goals School rules and laws related to tobacco Valid resources for drug problems Benefits of remaining drug free and making a drug-free commitment

Middle School High School & Other Drugs Units Middle School High School Alcohol, Tobacco, & Other Drugs Understand and apply the rules and laws related to alcohol and other drugs including over-the-counter and prescription medications. Understand internal and external influences on behavior and social norms related to alcohol and other drugs. Understand the potential health, social, and legal consequences of alcohol and other drug use and exposure. Apply verbal and nonverbal communication skills, including refusal skills, to avoid drug use and enhance health. Analyze situations for risk of alcohol and other drug use. Apply knowledge and skills to protect oneself and others from alcohol and other drug use and exposure and to support others who are abstaining from or trying to quit using drugs. Identify and locate reliable sources of information and assistance regarding alcohol and other drugs. Apply skills to advocate for changes in the school environment that would increase safety. Describe the short-term and long-term health consequences of alcohol, tobacco, and other drug use. Clarify myths regarding the scope of alcohol, tobacco, and other drug use among adolescents. Locate resources in one’s community and on the Internet for information and services regarding alcohol and tobacco use prevention and cessation; and assess the validity of these resources. Apply strategies to access and get help for self or others. Demonstrate skills to avoid tobacco exposure and avoid or resist using alcohol, tobacco, and other drugs. Describe financial, political, social, and legal influences regarding alcohol, tobacco, and other drugs. Analyze internal and external pressures to use alcohol, tobacco, and other drugs. Apply decision-making and problem-solving steps to hypothetical problems related to alcohol, tobacco, and other drug use. Demonstrate ways to support others who want to stop using alcohol or tobacco. Advocate for ways schools and communities can promote a tobacco-free environment. Present a persuasive solution to the problem of alcohol, tobacco, and other drug use among youth.

Michigan Model is responsive: New Tobacco Prevention Module: infused e-ciggs, hookah Opioid Misuse Prevention Infusion coming soon

Making the most of effective prevention: Parent and family involvement Family Homework assignments Teacher resources Opportunities to make examples relevant to your audience Skills-based instruction: Explain, model, guided practice, personalize Professional development for teachers (highly qualified teachers who are certified to teach health)

How can you use this information? Educate other stakeholders about best practices in prevention programs and strategies Advocate, explain and, persuade as to why certain programs/strategies are more effective Implement programs and interventions that are more likely to be effective and provide desired behavior change Use as a tool when choosing programs or interventions

What would you do if…….. The Superintendent of your local school wants an assembly on the dangers of drug use. You want to follow the principles of the Adapted Health Belief Model, so what recommendations would you make to change the assembly from a “stand alone” to a part of an effective prevention program?

Behaviors Knowledge Skills Self-Efficacy Environment

Form a group of two or three: Brainstorm three actions you can take to work with the Superintendent Develop a short conversation starter to use Report out

Prevention isn’t funded as well as the industries, so we need to be clear, concise and effective. We are the experts and can advocate for effective prevention programming in our schools and communities. Micki Fuhrman, Regional School Health Coordinator and Prevention Consultant mfuhrman@eatonresa.org