1. A Fundamental Principle of Prevention: Picking the Right Tool for the Job William B. Hansen, Ph.D. Tanglewood Research Greensboro, North Carolina

2. Rules about Tools To do it right, you need the right tool. When your only tool is a hammer, everything becomes a nail. No job is too small that it doesn’t require a new tool.

3. Fishing Tools Pole, line, lure/bait, hook Passive (depends heavily on the fish) Can produce sufficiently when things go well Is done primarily for sport and pleasure

4. Fishing If you give a man to fish, you feed him for one day. If you teach a man to fish, you feed him for the rest of his life. If you teach a man to fish, he will sit in a boat and drink beer all day!

5. Fishing Tools Spear or harpoon Active (depends heavily on the fisherman) Challenging and requires skill Is done primarily for survival

6. Fishing Tools Net Coordinated activity Very effective Is done primarily for commercial purposes

7. Basic Prevention Tools Categorized by Their Approach –Competency Enhancement –Motivation Building –Knowledge

8. Competency Approaches Decision Making Skills Goal Setting Skills Stress Management Skills Peer Pressure Resistance Skills Social Skills Interpersonal Problem Solving Skills Skills for Providing and Getting Help

9. Motivational Approaches Adoption of and Belief in Positive Peer Group Norms Development of Personal Commitments Define a Lack of Fit Between High- risk Behaviors and One’s Desired Lifestyle

10. Knowledge Approaches Beliefs about Social Consequences Beliefs about Health Consequences Beliefs about Short-term Consequences Beliefs about Long-term Consequences (Only Social & Short-term Consequences have research support)

11. Approaches Important for Prevention

12. Changes in Beliefs about Norms

13. Changes in Commitment to Not Use Substances

14. Changes in Resistance Skills

15. Rules for Selecting Prevention Tools Start with data –Local data if available –Published research data Select tools that are right for your population –Pick programs that have risk and protective factors that are important –Pick programs that have been shown to have promise Master delivery of the program

16. Program Fidelity Programs need to be delivered as intended Program results vary considerably based on how well the are delivered All programs require adaptation Make changes in consultation with experts Evaluation changes to insure they work

17. Changes in Targeted Outcomes Among 18 Groups

18. Coordinated Program Delivery Programs are most effective when: –Delivered with integrity –Integrated into the organization –Reinforced repeatedly by multiple people Ways to increase effectiveness include: –Delivery by teams who share responsibility –Active support from other adults –Active support from peer opinion leaders

19. An Example of Coordinated Prevention The Kentucky Field Trial of All Stars Three groups –Specialist-delivered program –Team-delivered program –Control group Pretest-posttest design All program groups received a program that emphasized: –Developing positive norms –Strengthening lifestyle (Idealism) –Strengthening personal commitments

20. Main Differences in Delivery Specialist –36 hours of training –14 40-minute class periods –2 one-on-one meetings with each student –570 minutes –visited classes as an expert Teacher –8 hours of training –38 15-minute class periods –one-on-one meetings not required –570 minutes –taught as a middle school team

21. Effects on Alcohol

22. Effects on Cigarette Smoking

23. Effects on Risk and Protective Factors

24. The Lesson Learned Both teacher and specialist approaches produced positive effects. Coordination increased effectiveness because: –multiple providers reinforce the message –prevention became infused and integrated into school and community life –targeted risk and protective factors were more likely to be changed

25. Conclusion Pick prevention tools that: –Fit the need of the population –Change what needs to be changed Deliver prevention programs: –With fidelity –As a team –Integrated with normal activities

26. Presentation Available at: http://www.tanglewood.net/powerpoint/prevention_tools.ppt