1. Principles of Effective Prevention Programs Karol L. Kumpfer, Ph.D. Professor Dept. of Health Promotion and Education University of Utah

2. Objectives Learn how to judge which programs are effective by effect size and matching risk and protective factors. Identify the 9 principles or components of successful prevention programming. Identify the 6 characteristics of successful program implementation. Use the principles to select and adapt the best model program for specific groups.

3. Principles of Prevention The field of alcohol and drug prevention has matured over the past 20 years. Research has identified the most effective prevention programs using literature reviews and meta-analyses. Federal agencies have lists of effective prevention programs and practices.

4. How to Decide on Best Prevention Program? Statistical Significance and/or Effect Sizes of Prevention Programs  Statistical Significance only tells you that the change in clients is not likely to have occurred by chance.  p.<.05 only means the change could have only occurred by chance only 5 times in a hundred  Effect Size tells you the size of the change in the youth getting the program versus those not getting the program.

5. SFP 10-14 Positive Results in Reduced Alcohol Initiation Effect Size is Difference in Reduced Alcohol Initiation in Sixth to Eight Graders in SFP 10-14 Schools vs. No- tx Control Schools

6. Better Programs Have High Effect Sizes An Effect Size of 1.00 means clients changed one standard deviation. A small effect size is generally d=.00 to.30 A medium effect size is d=.31 to.60 A large effect size is d=.61 and larger

7. Comparison of Average Program Effect Sizes (Tobler & Stratton, 1997; Tobler & Kumpfer, 2000) School-based Affective -.05 Knowledge plus Affective.05 Life or Social Skills Training.28  Average ES Youth-only Programs.10 ES Parent Skills Training.31 Family Skills Training.82 In-home Family Support 1.62  Average ES Family Interventions.96 ES

8. Principles of Prevention Federal Agencies Have Also Developed Lists of Prevention Principles  Office of National Drug Control Policy (ONDCP)  Kumpfer and associates (NIDA, 1997)  NIDA in “Red Book” 1997; 2003  Nation, et al., 2003; American Psychologist One Caveat: Principles do not Guarantee Program Effectiveness  Some program developers say their program works because it was designed on the basis of Principles of Prevention  Only actual outcomes can prove this.

9. Nine Principles of Effective Prevention Programs 1. Comprehensive Programs  Designed to enhance protective factors and reduce modifiable risk factors for all forms of substance abuse in the primary areas of influence, such as: Individual Characteristics Families Schools Peers Community  Focus on changing the environment to create enduring effects (family, community, school).

10. Nine Principles of Effective Prevention Programs (cont.) 2. Research-based/Theory-driven Programs  Effective programs are based on tested theoretical models of precursors of substance abuse, such as: Social Ecology Model (Kumpfer, et al., 2003) Social Development Model (Hawkins & Weis, 1987)  Prevention programs should target the precursors or causes of unwanted behaviors early before they begin (Hawkins & Catalano, 1992).

11. Nine Principles of Effective Prevention Programs (cont.) 3. Tailored to Participants Needs  Services should match the identified needs of the potential participants  Needs assessments can help to identify needs, such as the Communities That Care Student Survey (Hawkins & Catalano, 1992, Arthur, et al., 2000). CTC school survey measures 45 risk and protector factors It can be geographically coded to show community areas at highest need of prevention programs.

12. Nine Principles of Effective Prevention Programs (cont.) 4. Relevant Programs  Prevention programs are more effective when designed or adapted to be relevant to the target population Culturally-relevant Gender-sensitive Age-appropriate Locally relevant  Culturally-adapted, evidence-based prevention programs have been found to increase recruitment and retention by as much as 40% (Kumpfer, Alvarado, Smith, & Bellamy, 2002). What could you do to increase participation of parents in a school family skills training program?

13. Nine Principles of Effective Prevention Programs (cont.) 5. Intensive Enough to Address Major Needs  The more risk and protective factors or processes to be addressed, the greater the dosage or intensity needed to be effective.  Combining programs increases the intensity and improves the outcome effect sizes (Kumpfer, Alvarado, Tait, & Whiteside, 2002). Is a 2 hour drug education program likely to be effective for high risk youth?

14. Nine Principles of Effective Prevention Programs (cont.) 6. Appropriately Timed  Prior to the unwanted behavior.  Early enough to have an impact in changing developmental trajectories.  At critical transition points to a new environment, e.g., junior high or high school. Can you think of other critical transition times when youth are very vulnerable?

15. Nine Principles of Effective Prevention Programs (cont.) 7. Sufficient Follow-up or Boosters.  Prevention effects can decay with time if no booster sessions or reminders of skills learned.  With maturation, new material is needed that is developmentally-appropriate and addresses new risk factors. Would a three month prevention program designed for 1 st to 3 rd graders likely need “booster” sessions or new content for 6 th graders?

16. Nine Principles of Effective Prevention Programs (cont.) 8. Focus on Skills Development and Behavior Change  Active, hands-on-experience increases participant skills, even for staff training  Interactive teaching methods are more effective (Tobler, 1999). Is lecturing youth about the dangers of tobacco, alcohol or drug abuse likely to be as effective as having them consult expert sources and then debate the pros and cons of use?

17. Nine Principles of Effective Prevention Programs (cont.) 9. Involve Youth with Prosocial Role Models  Do not isolate high-risk youth with diagnosed problem behaviors together in groups without expert supervision (Dishion & Andrews, 1995).  Change the group norms to more healthy norms and values or  Clarify that the actual substance use rates or norms are lower than youth think (Perkins & Berkowitz, 1992). What methods can you use to accomplish this?

18. Implementation Fidelity Impacts Program Effectiveness Once you select the best evidence-based program, you must implement with fidelity  Fidelity means implementing all essential components (“the core elements) as originally designed, including: Structure Content Delivery (effective delivery only 21%)  Most practitioners tend to “water down” programs in the process of locally tailoring them.  Do not shorten or add new content, but you can adapt an exercise to be more relevant. If the curriculum specifies a welcome exercise where children say their name and favorite ice cream, how would you “adapt” this exercise for lactose intolerant Asian or American Indian youth?

19. Factors Contributing to Lack of Fidelity Lack of sufficient staff training Unclear training or implementation manuals Lack of understanding of critical elements Misinformation and laziness Lack of sufficient resources  Money  Staff  Facilities  Materials

20. Characteristics of Successful Program Implementation 1. Target Group Readiness and Desire for the Program  The staff, participants, and community should be “ready” to implement program  They should be aware of a substance abuse problem and ready to change  The PREVENT model can help with readiness assessments (NIDA, 1997)

21. Assessing Community Readiness to Start a Coordinated Prevention Approach (NIDA, 1997) Seven key factors that must be present: Problem defined by needs assessment Recognition of problem by community Existence of funding sources Vision/plan Energy to mobilize/sustain coalition Networking with stakeholders Talent/leadership

22. Characteristics of Successful Program Implementation (cont.) 2. Effective and Well Trained Staff  The characteristics of staff are critical to program effectiveness, such as: Warmth, Empathy, Genuineness (Truax & Carkfuff, 1967)  Staff rated more highly by clients get better results (Park & Kumpfer, 2005)  Staff training and supervision are essential for quality implementation (Dusenbury & Falco, 1995)

23. Characteristics of Successful Program Implementation (cont.) 3. Well Defined Plan  FORECAST (Goodman & Wandersman, 1994) 4. Sufficient Resources  Food, child care, transportation, attendance incentives,meals. 5. Interactive, Experiential Techniques 6. Evaluation Linked to Improvements

24. Summary Evidence-based Programs should be implemented that match youth needs. Effective programs have similar components (comprehensive, theory-based, adapted, relevant, intensive, age- appropriate, sufficient, change focused, and increase positive peer interaction) Lack of fidelity or successful implementation can compromise effectiveness.