Principles of Effective Prevention Programs

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.

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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.

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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.lt.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.

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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
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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

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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

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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.

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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).

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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).

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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.

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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?

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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?

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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?

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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 1st to 3rd graders likely need booster
  sessions or new content for 6th graders?

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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?

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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?

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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?

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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

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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)

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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

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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)

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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

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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.