School Substance Abuse Prevention Multiple Intervention Programs (HS)This is a featured page

This page contains a rough draft of a 10-15 page summary on multi-intervention programs delivered in and with schools to prevent substance abuse. This current draft contains sections of various materials from other sources that will be combined into a more finished product. Visitors to this page are invited to comment on these materials using the "thread" tool at the bottom of the page or to edit the page using the "EasyEdit" tool found at the top of the page.

Multiple Intervention Programs to Prevent Substance Abuse

The following points taken from the statement of broad implementation strategies in school health promotion published by the International School health Network apply to this issue of developing, implementing and sustaining multiple intervention programs in school substance abuse prevention.

1. Serve the whole child over the life course.

1. Address the needs of the whole child in a positive, principled approach over the life course. Understand the health/social problems and the impact of the school on those problems.

1.1 Programs should address the needs of the whole child (intellectual, social, physical, psychological, emotional) and identify and address all of the problems, assets, factors and conditions that affect their health, learning and development.

1.2 Prevent specific health and social problems but also build positive individual resilience and personal assets as well as family, community and organizational strengths.

1.3 Programs should promote values and respect principles such as empowerment, equity, ethics, social responsibility

1.4 Programs should be based on a recognition that health and social behaviours occur and develop over the life course.

1.5. Programs should be based on a clear, evidence-based understanding of the nature (protective & risk factors) and prevalence of the health or social problems being addressed.

1.6 Programs should be based on a clear understanding of the impact and effects of the social and physical environment of the school on the health or social problem being addressed.

4. Strive towards a comprehensive approach

4.1 Policy-makers, officials, administrators, and practitioners should build a comprehensive approach while simultaneously addressing specific urgent issues or the elements/programs within a coordinated set of interventions.

4.2 Holistic approaches can address clusters of problems and conditions.

4.3 Programs should be developed and implemented at multiple levels within systems and across several systems and then delivered using the school as a hub.

7. Coordinate multiple programs, services and policies.

7.1 Policy-makers, officials, administrators, and practitioners should coordinate several programs, policies, practices and services across five domains (policy, instruction, services, social environment, physical environment/resources) to achieve maximum impact in whole school and school-community strategies.

7.2 Policy-makers, officials, administrators, and practitioners should seek to influence the whole school environment, not just deliver programs or interventions within the school.

7.3 Policy-makers, officials, administrators, and practitioners should initiate, and support coordinated community-school programs.


School programs need to address urgent specific needs without losing sight of the long-term, capacity-building approach requited for sustainable, balanced, long-term success.

Application to school substance abuse prevention
(Contributors are invited to add statements of good practice or to identify implications related to the point being made on this page.)

  • Good/promising practice: Consider the use of scaffolding or stepped up programs as a means to develop a comprehensive approach over time (Canadian Association for School Health

Stepped up programming towards comprehensivenessThis is a featured page
This page discusses how schools can work towards comprehensive, coordinated and whole school approaches to prevention. Challenges and opportunities are identified.

By their nature, whole school approaches require still more attention to school readiness issues. Because these initiatives usually call for attention to the school environment, and closer ties with parents, often accompanied by new curricular programming, preparation is critical. Researchers associated with Australia’s Gatehouse project conclude that a great challenge for these approaches involving systemic changes is that they take a great deal of time and resources.[i]

It is possible that because of the breadth of the changes called for with this type of approach, schools may shy away from them. If this approach is presented to schools as another project to add on, they may indeed be very hesitant. The demands on schools to promote academic success and also implement various social and health programs advocated by community interests understandably make schools wary of another “add on” program. Schools are typically so preoccupied with ongoing instructional and management reforms that social and health programs are often seen as beyond the schools core business and dealt with “off the corner of the desk”.[ii] [iii]

Consequently, researchers increasingly claim that the long term success of comprehensive health and social programs lies in their ability to anchor them in the core mission of schools.[iv] [v] [vi] That is, they must fully accept that schools are first and foremost accountable for educating young people, and that they tend to become concerned with a problem when it is clearly a barrier to student learning. But the majority of students who end up having academic difficulties often experience a range of social/health barriers (e.g., violence, substance use issues, frequent school changes, and the numerous problems confronting recent immigrants and families living in poverty). So, a strong case can be made that these various social and health issues also represent barriers to learning, and call for schools, families, and communities to work together to address both through a comprehensive approach.[vii]

Gatehouse researchers found that many of the schools they worked with initially saw the project as a “welfare and student support” project. But through the process of implementation they found that a focus on student engagement and connectedness to school was a sound way to promote both emotional well-being and learning outcomes.[viii]

Adleman and Taylor point out that comprehensive approaches that are intended to support health and learning aims can paradoxically bring a new form of fragmentation. In many cases fragmentation arises because these initiatives focus mostly on linking community services to schools (e.g. substance abuse counselling) with too little thought given to connecting community programs with existing programs operated by the school. So, parallel (rather than integrated) programming can arise and personnel co-located at schools can find themselves operating in relative isolation of existing school programs and services. They point out that as a consequence a student identified as at risk for substance abuse, dropout, and suicide may be involved in three counselling programs operating independently of each other. Consequently various researchers have called for parties to move beyond program cooperation, and strive for program integration—with health/social advocates and educators working together to identify shared values, goals, and strategies.[ix] [x]

A long-term view is required when implementing comprehensive programs and policies. It is important to understand that these initiatives will not likely lead to immediate change at the individual level. So some researchers argue that other interim markers of success associated with process need to be identified earlier (e.g. level of student-teacher trust) to guide schools.[xi] Others suggest these initiatives be rolled out in sequence to minimize the strain on resources and to maintain interest. This was the approach taken by the government of the United Kingdom in its strategy to implement comprehensive school programming across that country in support of its national drug strategy.[xii]

To facilitate roll-out and effective relations between programs it may be helpful to consider a “stepped-care approach” as advocated by Abrams and Clayton (2001, p. 324).[xiii] A guiding principle of this model is the use of the least intensive (and expensive) level first and “stepping up” a “client” when a less intensive intervention has not been effective. Three steps are often proposed and in the school setting could take the following form:
Step 1: universal classroom and school-wide programming
Step 2: screening for higher-risk students who receive targeted brief motivational interventions
Step 3: more intensive clinical interventions for the smaller but important subgroup with severe problems

Comprehensive approaches often involve parents and this summary has found that the evidence for universal as well as targeted school-family programming is good. However, there are significant challenges to involving families in school programming. Programs seeking to involve parents often have problems reaching them. Participation rates tend to be very low and programs often fail to attract parents whose offspring are at the highest risk of substance use or other problems.[xiv] Stormshak (2005) reports on one approach at the middle school level, the Family Resource Centre (FRC), which allows for more focused attention to parent engagement. These centres, staffed by half-time professionals, deliver specific family programming and more generally support school personnel in their efforts to communicate and work with families. The study design was not controlled but the authors reported that FRC services significantly reduced the growth in problem behaviour over the three years of study.[xv]

Teacher training is an important consideration in the implementation of comprehensive programming. As has been reported earlier in this summary, the Gatehouse project included 40 hours of teacher training that was evenly divided between the curriculum and the environmental elements of the project. Another Australian study tested teacher training in the management of school substance use issues, and found that participating teachers demonstrated more favourable attitudes and practices in regard to integrated, supportive management of these issues in comparison to non-participating teachers; however they found little change in school practices. [xvi]

So, as is the case with classroom practices, it appears that training for policy or environmental change has some value, but needs to be a part of a broader, workforce development approach that accounts for the various factors involved with changes in school practices. This approach would also involve reviewing university teacher and school psychologist education to determine how best they can be prepared to contribute to comprehensive school approaches.[xvii] Any such effort needs to view teachers in a broad ecological perspective and examine ways that their training, development, and work as professionals can engage them to take part in efforts that attempt to create optimal environments for them and their students.[xviii] At the same time, social scientists and school health advocates need to receive more training to help them understand how to enter and work with school systems. Such training could help these professionals learn how best to develop joint agendas with schools to improve the range of student outcomes discussed in this knowledge summary.[xix]

[i] Bond, L., Glover, S., Godfrey, C., Butler, H., & Patton, G.C. (2001). Building capacity for system-level change in schools: Lessons from the gatehouse project. Health Education and Behavior, 28(3), 368-383.
[ii] Toumbourou, J.W., Rowland, B., Jefferies, A., Butler, H., & Bond, L. (2004). Preventing drug-related harm through school re-organisation and behavior management [Prevention research evaluation report No. 12]. Melbourne, Australia: Australia Drug Foundation. Retrieved September 30, 2007, from http://www.druginfo.adf.org.au/downloads/Prevention_Research_Quarterly/PRQ_04Nov_Early_intervention_in_schools.pdf
[iii] Stormshak, E.A., Dishion, T.J., Light, J., & Yasui, M. (2005). Implementing family-centered interventions within the public middle school: Linking service delivery to change in student problem behavior. Journal of Abnormal Child Psychology, 33(6), 723-733.
[iv] Adelman, H.S., & Taylor, L. (2003). Creating school and community partnerships for substance abuse prevention programs. The Journal of Primary Prevention, 23(3).
[v] Stormshak, E.A., Dishion, T.J., Light, J., & Yasui, M. (2005). Implementing family-centered interventions within the public middle school: Linking service delivery to change in student problem behavior. Journal of Abnormal Child Psychology, 33(6), 723-733.
[vi] Toumbourou, J.W., Rowland, B., Jefferies, A., Butler, H., & Bond, L. (2004). Preventing drug-related harm through school re-organisation and behavior management [Prevention research evaluation report No. 12]. Melbourne, Australia: Australia Drug Foundation. Retrieved September 30, 2007, from http://www.druginfo.adf.org.au/downloads/Prevention_Research_Quarterly/PRQ_04Nov_Early_intervention_in_schools.pdf
[vii] Adelman, H.S., & Taylor, L. (2003). Creating school and community partnerships for substance abuse prevention programs. The Journal of Primary Prevention, 23(3).
[viii] Bond, L., Glover, S., Godfrey, C., Butler, H., & Patton, G.C. (2001). Building capacity for system-level change in schools: Lessons from the gatehouse project. Health Education and Behavior, 28(3), 368-383.
[ix] Adelman, H.S., & Taylor, L. (2003). Creating school and community partnerships for substance abuse prevention programs. The Journal of Primary Prevention, 23(3).
[x] Stormshak, E.A., Dishion, T.J., Light, J., & Yasui, M. (2005). Implementing family-centered interventions within the public middle school: Linking service delivery to change in student problem behavior. Journal of Abnormal Child Psychology, 33(6), 723-733.
[xi] Inchley, J., Muldoon, J., & Currie, C. (2007). Becoming a health promoting school: Evaluating the process of effective implementation in Scotland. Health Promotion International, 22(1), 65-71.
[xii] Baker, P.J. (2006). Developing a Blueprint for evidence-based drug prevention in England. Drugs: Education, Prevention and Policy, 13(1), 17–32.
[xiii] Abrams, D. B., & Clayton, R. R. (2001). Transdisciplinary research to improve brief interventions for addictive behaviors. In P. M. Monti, S. M. Colby & T. A. O'Leary (Eds.), Adolescents, alcohol, and substance abuse: Reaching teens through brief interventions. Retrieved September 30, 2007, from http://ajp.psychiatryonline.org/cgi/reprint/159/11/1958
[xiv] Stormshak, E.A., Dishion, T.J., Light, J., & Yasui, M. (2005). Implementing family-centered interventions within the public middle school: Linking service delivery to change in student problem behavior. Journal of Abnormal Child Psychology, 33(6), 723-733.
[xv] ibid
[xvi] Midford, R., Wilkes, D., & Young, D. (2005). Evaluation of the in touch training program for the management of alcohol and other drug use issues in schools. Journal of Drug Education, 35(1), 1-14.
[xvii] Greenberg, M.T., Weissberg, R.P., O’Brien, M.U., Zins, J.E., Fredricks, L., Resnik, H., et al. (2003). Enhancing school-based prevention and youth development through coordinated social, emotional, and academic learning. American Psychologist, 58, 466–474.
[xviii] Berryhill, J.C., & Prinz, R.J. (2003). Environmental interventions to enhance student adjustment: Implications for prevention. Prevention Science, 4(2), 65-87.
[xix] ibid

Address clusters of related problems & conditions.This is a featured page
This page begins a discussion of how individual school programs can address several related problems and needs. For example, when schools and agencies work together to implement alternatives to suspending students from school, this reduces dropout rates, reduces crime levels and descreases the risk of those students turing to alcohol, tobacco and drugs. (Use the "Thread" tool at the bottom of the page) and/or to suggest research, resources, experts, examples and other information related to this point (Use the Easy Edit at the top of the page to add suggestions directly on the page).


Application to school substance abuse prevention
Contributors are invited to add statements of good practice or to identify implications related to the point being made on this page.)

  • Good/promising practice 12: at the elementary school level, implement comprehensive programs that focus on improving parenting skills and modifying teaching practices; these programs can increase school commitment and school achievement, and reduce misbehaviour, lifetime violence, sexual activity and hazardous drinking over the long-term (Canadian Association for School Health, p.45) Go to Comprehensive elementary programs to address multiple behaviours to discuss this practice.

  • Good/promising practice 13: at the junior high/middle school level, implement comprehensive programs that give attention to substance education as well as the school environment; these initiatives can be effective in reducing substance use, mental health problems, early sexual activity, and antisocial behaviour. (Canadian Association for School Health, p. 46) Go to Middle/junior high programs to discuss this practice.

  • Principle 2. Drug-related learning outcomes should be addressed in the context of the health curriculum or other appropriate learning area that can provide sequence, progression, continuity and links to other health issues that impact on students’ lives. Isolated programmes cannot provide the ongoing comprehensive and developmental elements that encourage development of personal and social skills and values. Just as drug abuse does not exist in a vacuum but is part of the young person’s whole life, education for prevention should incorporate other issues important to young people, including adolescent development, stress and coping, sexuality, collaboration between home and school and personal relationships. (UN Office on Drugs & Crime) Go to Integrating drug education in comprehensive health education curricula for a discussion of this practice

Comprehensive elementary programs to address multiple behavioursThis is a featured page

A growing body of research that includes a number of controlled studies suggests that interventions focusing on improving primary school environments can contribute to better learning outcomes while also reducing pathways to harmful substance use.[i] Below are two elementary level programs that aimed to build school bonding among students as a route to promoting academic success and preventing later behavioural problems.

The Seattle Social Development Project, developed by Hawkins and colleagues, is a universal intervention for students in Grades 1-6 that combines parent training with modified teaching practices. The intervention was conducted in 18 Seattle elementary schools, with students randomly assigned to experimental or control classrooms. The teachers were trained in proactive classroom management (i.e. providing clear expectations for behaviour, recognizing and rewarding compliance, use of encouragement and praise), interactive teaching, and cooperative learning. The parent training component consisted of optional parent classes offered in first through third grades, covering child behaviour management, academic support through improved communication, and prevention of antisocial behaviour.[ii]

The 6-year follow-up compared results for three groups of students: those who had received a “full intervention” (grades 1 through 6), those who had received a “late intervention” (grades 5 and 6 only), and a no-intervention control group. The late intervention group showed little long-term effect while the full intervention group scored significantly higher than the control group on measures of school commitment and attachment, school achievement, misbehaviour, lifetime violence and sexual activity by age 18. At the end of high school, heavy drinking was reported by fewer of the students who had received the full intervention (15.4 per cent) relative to those in the control schools (25.6 per cent).

The researchers speculate that the program’s emphasis on school bonding and achievement may set children on a developmental path toward school completion and success that is naturally reinforced both by teachers responsive to motivated students and by the students’ own commitment to schooling.

The Child Development Project developed by Battistich and colleagues was intended to transform schools into “caring communities of learners”. Components include school staff training in the use of cooperative learning and a language arts model that fostered cooperative learning, buddy activities, and classroom decision-making. School-wide community-building activities were used to promote school bonding and parent involvement activities, such as interactive homework. This program was evaluated in a quasi-experimental study with 4,500 third to sixth grade students (average age 11 years) in 24 schools. Intervention and control schools were well matched. Results showed improvements in interpersonal and problem solving skills and in substance use and anti-social behaviour. When a sample of students was followed up in middle school, a number of positive effects were maintained, however effects on alcohol and cannabis use were no longer evident.[iii]

[i] Toumbourou, J.W., Stockwell, T., Neighbors, C., Marlatt, G.A., Sturge, J., & Rehm, J. (2007). Interventions to reduce harm associated with adolescent substance use: An international review. Lancet, 369, 1391-1401.
[ii] Toumbourou, J.W., Rowland, B., Jefferies, A., Butler, H., & Bond, L. (2004). Preventing drug-related harm through school re-organisation and behavior management [Prevention research evaluation report No. 12]. Melbourne, Australia: Australia Drug Foundation. Retrieved September 30, 2007, from http://www.druginfo.adf.org.au/downloads/Prevention_Research_Quarterly/PRQ_04Nov_Early_intervention_in_schools.pdf
[iii] Battistich, V., Schaps, E., & Wilson, N. (2004). Effects of an elementary school intervention on students’ “connectedness” to school and social adjustment during middle school. The Journal of Primary Prevention, 24(3).

Middle/junior high programs to address multiple issuesThis is a featured page

Less research has been conducted on the effectiveness of social environments at the middle and high school level. The available research is inconclusive, but does suggest that secondary school re-organization and behaviour management practices may influence young people’s drug use.
[i] Dewit and colleagues (2002) reviewed this literature and identified several fundamental ingredients or components of school bonding or connectedness interventions that must be present to increase the likelihood of positive change in student learning and behavioural outcomes:[ii]
  • Efforts to change the social environment of schools should be guided by an overarching set of principles that when implemented help to organize and guide the selection of programs and strategies (e.g. social development, or schools as community models). Incorporating these principles into the fabric of whole school programs allows the activities associated with one program component to reinforce and complement the activities of another and hence improve the likelihood of positive student outcomes.
  • School reforms aimed at improving sense of school connections and other student outcomes need to recognize that children’s educational experiences occur within several imbedded contexts, starting at the classroom level and extending outwards to broader contextual influences. Programs that focus on just one of these areas at the exclusion of the others are less likely to succeed.
  • Programs that target school connectedness need to be sensitive to the developmental needs of students. For example, secondary students need to provide opportunities for decision-making at the classroom level at a time when there is a growing need for autonomy and independence.
  • Sustainable committees or networks consisting of students, teachers, administrators, parents, and members of the community operating according to a specified framework for action are needed.
  • Finally, whole-school programs may be effective in preventing the escalation of some behavioural problems but are unlikely to address the specific needs of individuals with severe problems. For this reason, school-connectedness programs should be supplemented with specialized in-school services such as student assistance programs that provide referrals, service recommendations, and follow-up support programs for students in greatest need of help.
The Gatehouse Project reflects much of this advice and provides the best evidence of the potential for this approach at the middle/high school level. It is a well-evaluated initiative focused on Grade 8 students in 26 schools in Melbourne, Australia that aimed to improve the emotional well-being of secondary students through both individual- and environment-focused approaches. Rather than providing a set program, Gatehouse involved a structured process comprising:
  • feedback from a student survey about students’ sense of personal safety, communication with teachers, and participation in broader school life;
  • recruitment of staff in each school to a coordinating action team;
  • an average of 40 hours of consultation and training for staff on specific curriculum or whole school strategies.
The interventions included:
  • the individual-focused curriculum: an average of 15 hours of instruction in English, Health, or Personal Development classes that aimed to enhance understanding and skills for dealing with difficult situations and emotions;
  • the environment focus: using whole-school strategies to address particular risk and protective factors in the school environment identified in the review of the current situation.
Strategies varied between schools according to students’ perception of the situation, but the implementation of school policy and curriculum elements that focused on social and emotional skills and strategies to promote inclusive relationships in the classroom were a part of all initiatives. The project has been evaluated through a randomised, controlled trial design, and at 4-year follow-up a 25% reduction in marked health risk behaviours (i.e. substance use, early sexual activity, antisocial behaviour) was found between the intervention and control schools.[iii] Interestingly, no differences on measures of school engagement or emotional problems were found between the two groups at 4-year follow-up. An Alberta adaptation of the Gatehouse Project, Creating Opportunities for Resilience and Engagement (CORE) consists of a trial in 60 schools with a roll out and test in 8 schools per year. As with the Gatehouse project, the main goal is to reduce depression and the first pilot school is already showing impacts on substance use. CORE involves the original Gatehouse investigators as collaborators. It differs from the original Gatehouse in that it targets teachers and the school as a workplace as the first principle; it measures social connectedness differently; and it lasts for three years instead of two. Importantly, the CORE trial will also include an economic evaluation, calculating the cost per case of smoking prevented and the cost per case of depression prevented.[iv]

[i] Toumbourou, J.W., Stockwell, T., Neighbors, C., Marlatt, G.A., Sturge, J., & Rehm, J. (2007). Interventions to reduce harm associated with adolescent substance use: An international review. Lancet, 369, 1391-1401.
[ii] DeWit, D.J., Akst, L., Braun, K., Jelley, J., Lefebvre, L., & McKee, C. (2002). Sense of school membership: A mediating mechanism linking student perceptions of school culture with academic and behavioural functioning. Toronto, Canada: Centre for Addiction and Mental Health.
[iii] Patton, G., Bond, L., Carlin, J., Thomas, L., & Butler, H., et al. (2006). Promoting social inclusion in schools: A group-randomized trial of effects on student health risk behavior and well-being. American Journal of Public Health, 96(9).
[iv] University of Calgary, Population health intervention research centre. (n.d.). Feeling alienated at school: how risky health behaviours start. Retrieved August 31, 2007, from http://www.ucalgary.ca/PHIRC/snapshots.html

Make changes at multiple levels.This is a featured page

Programs introduced by individual teachers, nurses or schools need to be supported by corresponding changes at the school board/health authority/agency and ministry level as well as by federal and national agencies that often fund research and demonstration projects.. For example, when schools and local work together to implement alternatives to suspending students from school they need to have support from local agencies and from government ministries that there will be coordinated policies with police, services, that there will be family services to intervene with the child's parents and that there will be funding for programs such as restorative justice and addictions treatment services.


7. Coordinate multiple programs, services and policies.

7.1 Policy-makers, officials, administrators, and practitioners should coordinate several programs, policies, practices and services across five domains (policy, instruction, services, social environment, physical environment/resources) to achieve maximum impact in whole school and school-community strategies.

7.2 Policy-makers, officials, administrators, and practitioners should seek to influence the whole school environment, not just deliver programs or interventions within the school.

7.3 Policy-makers, officials, administrators, and practitioners should initiate, and support coordinated community-school programs.


7.1 Develop a shared vision, select a coordination modelThis is a featured page This page begins a discussion about why and how school prevention programs should be based on a shared vision and a coherent planning model. (Use the "Thread" tool at the bottom of the page) and/or to suggest research, resources, experts, examples and other information related to this point and sub-points. (Use the Easy Edit at the top of the page to add suggestions directly on the page).

Policy-makers, officials, administrators, and practitioners should coordinate several programs, policies, practices and services across five domains (policy, instruction, services, social environment, physical environment/resources) to achieve maximum impact in whole school and school-community strategies.

There are several models of school-based and school-linked models that have been developed and used around the world. These include terms such as Health Promoting Schools, Coordinated School Health Programs, Comprehensive School Health, Healthy Schools, School Health & Nutrition programs, Safe Schools, Community Schools, Effective/Good Schools, Child Friendly Schools as well as more specific terms related to individual or groups of health or social problems.

Application to school substance abuse prevention
(Contributors are invited to add statements of good practice or to identify implications related to the point being made on this page.)

  • Good/promising practice UNODC There are several components of a school-based drug abuse prevention education and intervention programme, including:
    Education:
- school-based education for drug abuse prevention - A safe and supportive school environment - Strategies for ensuring that all members of the school community contribute to and support school policies - Appropriate professional development and training for relevant staff - Information and support for parents, - Mechanisms for continuous monitoring and review of the school’s approach

Examples of comprehensive (multi-issue, multi-level, multi-system) approaches

Examples of coordinated agency-school-community SA prevention programsThis is a featured page

Interest in school-community partnerships on various issues has burgeoned in recent years. These initiatives reflect various levels of formality and orientation but they generally share a recognition that single issue/single intervention efforts are less likely to succeed and tend to fragment precious resources. Some partnerships are connected to efforts to reform community health and social services; some stem from the youth development movement; a few are driven by school reform; and a few others arise from community development initiatives.[i] These programs are sometimes referred to as school-linked services, defined in Adelman and Tayor (2003) as “the coordinated linking of school and community resources to support the needs of school-aged children and their families” (p. 353). These initiatives differ in terms of the degree of system change required and have been categorized as informal, coordinated, partnerships, collaborations, or integrated services.[ii]

As would be anticipated, most initial efforts focus on developing informal relationships and beginning to coordinate services. They may have any number of specific aims that in some way address substance abuse concerns, for example:
  • improve access to health services (including substance abuse programs) and access to social service programs, such as foster care, child care;
  • expand after-school academic, recreation, and enrichment, such as tutoring, youth sports and clubs, art, music, museum programs;
  • build systems of care, such as case management and specialized assistance;
  • reduce anti-social behaviour (preventing drug abuse and truancy, providing conflict mediation and reducing violence);
  • enhance transitions to work/career/post-secondary education, and;
  • enhance life in school and community, such as programs to adopt-a-school, use of volunteer and peer supports, and building neighbourhood coalitions.

As Adelman and Tayor (2003) report, the logic of comprehensive, school-linked approaches is appealing, however their complexity can be overwhelming, and implementation and evaluation extremely daunting.[iii] Due to the poor methodology of the studies that have examined multi-component programmes, Flay (2000) found little evidence that combining 'social environment change' (such as parent training, mass media and community-wide programmes) with school-based interventions was more effective than delivering school-based interventions alone.[iv] However, the Tobler et al meta-analysis (2000) found that “system-wide change” programs significantly increase the effect size of classroom programs (i.e. system-wide change =.27; and social influences: = .12; life-skills = .17 on their own). They identified two kinds of system-wide change programs: those that focus on shifting school climate and/or engage students in the learning process (as discussed in the previous section); and broader schemes supported by families and communities.

Project Northland is a rare example of a rigorously evaluated long-term school-community project.[v] It was designed as a multi-component intervention that included demand (individual level) and supply (environmental-level) reduction strategies. In this way, Project Northland sought not only to teach students skills to effectively negotiate social influences to drink — but, at the same time, attempted to directly modify the social environment of youth (i.e., peers, parents, school, and community).[vi]

Designed to prevent or reduce alcohol use among students, the intervention was conducted in three phases in 20 randomized school districts. Phase 1 was delivered when the students were in grades 6 to 8 and included a school-based program (social influence curriculum with peer leaders), parental education, peer leadership of alcohol-free extracurricular activities, and community-wide task forces. An interim (second) phase of the study occurred when the students were in grades 9 and 10. During those years, only minimal intervention (i.e., a short classroom program) took place. Phase 3 was implemented when the students were in grades 11 and 12 and focused on community organization and policies to reduce youth access to alcohol (e.g., responsible beverage service). Other components included a school-based curriculum on the legal consequences of underage alcohol use, parent education, print advertising of community events, and a campaign to discourage providing alcohol to adolescents.[vii]

Patterns of alcohol use between the intervention and control groups were analyzed for each phase. During Phase 1, the increase in alcohol use was significantly greater in the control group when compared with the intervention group. Conversely, during the interim phase the increase in alcohol use was significantly greater in the intervention group when compared with the control group. During this phase, the students in the intervention group seemed to return to the level of drinking that was normative in their communities. During Phase 3, the increase in alcohol use was again greater in the control group than in the intervention group, however, the effect was not as strong as was found in Phase 1. A significant reduction in alcohol sales to underage persons in the intervention group was reported in this phase.[viii] At 4-year follow-up there were no significant effects of the Project Northland intervention over the control group.

To address the need for more information on the effectiveness of components of comprehensive programs, Stigler et al (2006) conducted a later analysis of the five Phase I components: classroom curricula, peer leadership, youth-driven/led extra-curricular activities, parent involvement programs, and community activism. They found that the strongest effects were documented for the planners of extra-curricular activities and parent program components. The classroom curricula showed moderate effectiveness, while the community activism component failed to showed effect. The authors noted that “The interactions tested here did not provide support for synergistic effects between selected intervention components” (p. 269).

[i] Adelman, H.S., & Taylor, L. (2003). Creating school and community partnerships for substance abuse prevention programs. The Journal of Primary Prevention, 23(3).
[ii] ibid
[iii] ibid
[iv] Flay, B.R. (2000). Approaches to substance use prevention utilizing school curriculum plus social environment change. Addictive Behaviors, 25(6), 861-885.
[v] Perry, C. L., Williams, C. L., Komro, K.A., Veblen-Mortenson, S., Stigler, M.H., & Munson, K. (2002). Project northland: Long-term outcomes ofcommunity action to reduce adolescent alcohol use. Health Education and Behavior, 17(1), 117-132.
[vi] Stigler, M.H., Perry, C.L., Komro, K.A., Cudeck, R., & Williams, C.L. (2006). Teasing apart a multiple component approach to adolescent alcohol prevention: What worked in project northland? Prevention Science, 7, 269-280.
[vii] Perry, C. L., Williams, C. L., Komro, K.A., Veblen-Mortenson, S., Stigler, M.H., & Munson, K. (2002). Project northland: Long-term outcomes of community action to reduce adolescent alcohol use. Health Education and Behavior, 17(1), 117-132.
[viii] ibid


Examples of whole school SA prevention strategiesThis is a featured page

Conclusion

Policy-makers, officials, administrators, and practitioners should initiate, and support community-school Interactions.
School participation in community-based programs and services is often essential. Schools often serve to recruit, publicize, refer and support students participating in programs. Schools often welcome representatives from these programs to speak with students, staff or parents. Schools and school boards can form community advisory committees. Schools, school boards and representatives of educators can participate in community councils, state/provincial coalitions and national networks. Such professional/community networking has proved to be effective in advocating for and supporting school programs.

Application to school substance abuse prevention
(Contributors are invited to add statements of good practice or to identify implications related to the point being made on this page.)


  • Good/promising practice 15: understanding that many of the factors contributing to student substance use problems fall outside the purview of the school, consider linking and integrating school and community programs; doing so can address a broader range of individual and environmental factors and may delay use of alcohol among adolescents more so than either initiative on their own. (Canadian Association for School Health, p.49) Go to Coordinated school-community programs/strategies to discuss this practice.

  • Good/promising practice 16: for late elementary school level families, consider linking to universal family skills programs in the community that aim to develop relationship skills among family members; these programs reduce student alcohol use and violence over the long-term and are cost effective. (Canadian Association for School Health, p.50) Go to School-linked universal family programs to discuss this practice.

  • Good/promising practice CICAD 15 Recent studies and research have demonstrated that the use of coordinated multiple interventions is more effective than individual interventions. The use of coordinated multiple interventions requires the involvement of a variety of community-based organizations, agencies and professionals to provide support to schools so that the whole task is not left to teachers alone. (Organization of the American States)



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