Transcript Slide 1
From Practice Wisdom to Prevention Science: Advances in Preventing Drug Abuse Among Young People
J. David Hawkins Social Development Research Group School of Social Work University of Washington www.sdrg.org
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Early Drug Abuse Prevention Research Findings
• Tested approaches were largely
ineffective
(Elmquist, 1995; Hanson, 1992; Moskowitz, 1989).
• Drug information programs
increased drug use in some studies
(Tobler, 1986).
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The Premise of Prevention Science To prevent a problem before it happens, the factors that predict the problem must be changed.
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To Prevent, Address Predictors Epidemiologic and etiologic studies have identified risk and protective factors that influence health and behavior. These should be targeted by preventive interventions.
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Advances in Prediction
•
Studies following children over time have identified predictors of substance abuse, depression, violence, teen pregnancy, and other problem behaviors – Called : Risk factors.
•
AND Studies have identified predictors of positive outcomes including success in school and avoiding health risk behaviors- Called : Promotive and protective factors.
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Promotive and Protective Factors:
• Individual Characteristics •
High Intelligence
• •
Resilient Temperament Competencies and Skills
• In each social domain (family, school, peer group
and neighbourhood)
•
Prosocial Opportunities
• • •
Reinforcement for Prosocial Involvement Bonding or Connectedness Clear and Healthy Standards for Behavior
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Risk Factors for Adolescent Problem Behaviors
Risk Factors Community Availability of Drugs Availability of Firearms Community Laws and Norms Favorable Toward Drug Use, Firearms, and Crime Media Portrayals of Violence Transitions and Mobility Low Neighborhood Attachment and Community Disorganization Extreme Economic Deprivation
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Used by permission of Channing Bete Company
Risk Factors for Adolescent Problem Behaviors
Risk Factors Family Family History of the Problem Behavior Family Management Problems Family Conflict Favorable Parental Attitudes and Involvement in the Problem Behavior
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Used by permission of Channing Bete Company
Risk Factors for Adolescent Problem Behaviors
Risk Factors School Academic Failure Beginning in Late Elementary School Lack of Commitment to School
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Used by permission of Channing Bete Company
Risk Factors for Adolescent Problem Behaviors
Risk Factors Individual/Peer Early and Persistent Antisocial Behavior Rebelliousness Friends Who Engage in the Problem Behavior Favorable Attitudes Toward the Problem Behavior Early Initiation of the Problem Behavior Constitutional Factors
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Used by permission of Channing Bete Company
Controlled Trials Are Necessary
Careful experimental evaluation enables identification of programs and policies that can prevent health and behavior problems. 11
SPR’s Standards of Evidence provide criteria for conducting efficacy and effectiveness trials
View them on line at : – www.preventionresearch.org
– Use them to identify tested and effective preventive policies and programs 12
Advances Have Been Made through Efficacy Trials
Rigorous evaluations have identified both ineffective and effective prevention policies, programs and actions.
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What Doesn’t Work?
*Negative Effects
•
Waivers to Adult (Criminal Courts)*
• • •
“Scared Straight”* D.A.R.E.
Guided Group Interaction & Positive Peer Culture
•
Peer Counseling Programs
•
Summer Job Programs ( for at risk youth)
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Effective Programs and Policies Have Been Identified in a Wide Range of Areas
Prenatal & Infancy Programs Early Childhood Education 8.
Classroom Organization, Management, and Instructional Strategies Parent Training After-school Recreation 9.
School Behavior Management Strategies Mentoring with Contingent Reinforcement 10.
Classroom Curricula for Social Competence Promotion Youth Employment with Education 11.
Community & School Policies Organizational Change in Schools 12.
Community Mobilization
(Hawkins & Catalano, 2004)
Replicated Effective Substance Abuse and Violence Prevention Programs
Nurse Family Partnership The Incredible Years Promoting Alternative Thinking Strategies Bullying Prevention Program Life Skills Training Midwestern Prevention Project Toward No Drug Abuse Big Brothers Big Sisters Multidimensional Treatment Foster Care*** Multisystemic Therapy Functional Family Therapy Source: Center for the Study and Prevention of Violence: Blueprints Project, University of Colorado. Delbert Elliott P.I.
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The Incredible Years
Description: Target:
Parent, teacher, and child training to promote emotional and social competence in early childhood Children ages 3-7 and their parents and teachers
Contact:
Carolyn Webster-Stratton University of Washington, School of Nursing Department of Family and Child Nursing 1107 NE 45th St., Suite 305 Seattle, WA 98105-4631 (206) 543-6010 17
The Incredible Years
Evidence of Effect
Parent Program: • Reduced conduct problems. • Increases in positive affect and compliance to parental commands.
Teacher Program: • Reductions in peer aggression in the classroom.
• Increases in positive affect and cooperation with teachers, positive interactions with peers, school readiness and engagement with school activities.
Child Program: • Reductions in conduct problems at home and school.
• Improved cognitive problem-solving strategies with peers.
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Life Skills Training
Description:
Curriculum for social competence promotion and drug abuse prevention
Target:
Students ages 11 to 14.
Contact:
Gilbert Botvin, Ph.D., Director Institute for Prevention Research Cornell University Medical College 411 East 69th Street, KB-201 New York, NY, 10021 212-746-1270 19
Life Skills Training
Evidence of Effect
• Reduces tobacco, alcohol, and marijuana use 50-75%.
• Effects maintained through grade 12.
• Cuts polydrug use up to 66%.
• Reduces pack-a-day smoking by 25%.
• Decreases use of inhalants, narcotics, and hallucinogens 25% to 55%.
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Guiding Good Choices
(Preparing for the Drug Free Years) Description:
Workshops to help parents build family bonding, establish clear and consistent guidelines for children’s behavior, teach children skills to resist peer influence, improve family management practices, and reduce family conflict.
Target: Contact:
Parents of children ages 9 to 14.
J. David Hawkins & Richard Catalano University of Washington Available from: Channing Bete Company www.channing-bete.com
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Guiding Good Choices
Evidence of Effects
Reduced drug use through age 18 (Mason et al, 2003).
Reduced growth in delinquency through age 16 (Mason et al., 2003).
Reduced growth in depression through age 18 (Mason et al., 2007).
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Seattle Social Development Project Social Development Research Group School of Social Work University of Washington
J. David Hawkins – Principal Investigator Karl G. Hill, Richard Catalano, Rick Kosterman, Robert Abbott, Todd Herrenkohl – Investigators Jennifer Bailey, Sabrina Oesterle, Research Scientists Funded by National Institute on Drug Abuse; National Institute of Mental Health; National Institute on Alcohol Abuse and Alcoholism; Office of Juvenile Justice and Delinquency Prevention; Robert Wood Johnson Foundation 23
Theoretical Foundation
• SSDP is guided by the Social Development Model (Hawkins & Weis, 1985; Catalano & Hawkins, 1996).
• • • • The SDM is an integrative developmental theory that includes aspects of social learning theory social control theory differential association theory.
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The Social Development Model
Prosocial opportunities Prosocial involvement Prosocial rewards Bonding to prosocial others
PROSOCIAL PATH
Belief in the moral order External constraints: Laws, norms, family & classroom standards Position in the social structure: race, SES, age, gender Individual constitutional factors ( + ) ( ) Antisocial opportunities Skills for interaction Antisocial involvement Antisocial rewards Antisocial Behavior Bonding to antisocial others Belief in antisocial values
ANTISOCIAL PATH
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The Social Development Strategy
The Goal… Ensure… Build… Healthy Behaviors Healthy Beliefs and Clear Standards Bonding –Attachment –Commitment …for all children and youth
…
in families, schools, and peer groups …to families, schools, and peer groups By providing… Opportunities Skills Recognition
…
in families, schools, and peer groups Be Aware of … Individual Characteristics
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Social development in a parent child interaction.
Parent-Child Interaction Coded for Opportunities Involvement Rewards Bonding etc.
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SSDP
Overview
A longitudinal study of the etiology of positive and antisocial behaviors.
An intervention study nested in the longitudinal study.
Initiated in 1981 in eight Seattle elementary schools.
Expanded in 1985 to include 18 Seattle elementary schools that over represented children from high crime neighborhoods. 808 (77%) of the 5 th grade students in these schools and their parents consented to participate in the longitudinal study. They constitute the SSDP sample.
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SSDP: Gender, Ethnicity & SES
• Gender
Female 396 49% Male 412 51%
• Ethnic Group
European-American African-American Asian-American Native-American of these were Hispanic 381 207 177 43 44 47% 26% 22% 5% 5%
• SES
Eligible for free/reduced lunch (5 th ,6 th or 7 th ) 423 52%
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SSDP Panel Retention
Longitudinal data have been collected on these Seattle youths and their parents from 1985 to 2005 (age 30). Elementary Middle High Adult
MEAN AGE G2 N % 10 808 11 703 87% 12 13 14 15 16 (17) 18 21 24 27 558 654 778 783 770 - 757 766 752 747 69% 81% 96% 97% 95% - 94% 95% 93% 93%
Interview completion rates for the sample have remained above 93% since 1989, when subjects were 14 years old.
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SSDP Design
• Initiated full intervention and control conditions
in 1981 in 8 Seattle elementary schools.
• Expanded in 1985 to 18 Seattle elementary schools
to add a late intervention condition, a parent training only condition, and additional control students.
• Quasi-experimental study
Full treatment (grades 1-6) = 149 Late treatment (grades 5-6) = 243 Control = 206 Parent training only (grades 5-6) = 210
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Family School X X X X X X Individual/Peer X X X
Risk Factors Addressed By SSDP
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Social Development Intervention
SSDP Intervention
Prosocial opportunities Prosocial involvement Prosocial rewards
PROSOCIAL PATH
Bonding to prosocial others Healthy Standards for Behavior External constraints: Norms Family & Classroom Management Position in the social structure: race, SES, age, gender Individual constitutional factors Antisocial opportunities ( + ) Skills for interaction Antisocial involvement ( ) Antisocial rewards ( +, Positive Behavior Problem Behavior Bonding to antisocial others Unhealthy values
ANTISOCIAL PATH
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SSDP: Intervention Components
Component One:
in Classroom Instruction and Management Teacher Training
Component Two:
Parent Training in Behavior Management and Academic Support
Component Three:
Child Social and Emotional Skill Development
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SSDP Interventions: Teacher Education Intervention Component Skill Area Teacher education in classroom management and instruction Proactive classroom management (grades 1-6)
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Interactive teaching (grades 1-6) Cooperative learning (grades 1-6) Specific skills taught
Establish consistent classroom expectations and routines at the beginning of the year
Give clear, explicit instructions for behavior
Recognize and reward desirable student behavior and efforts to comply
Use methods that keep minor classroom disruptions from interrupting instruction
Assess and activate foundation knowledge before teaching
Teach to explicit learning objectives
Model skills to be learned
Frequently monitor student comprehension as material is presented
Re-teach material when necessary
Involve small teams of students of different ability levels and backgrounds as learning partners
Provide recognition to teams for academic improvement of individual members over
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past performance
SSDP Parent Workshops
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Behavior management skills (grades 1-2) Observe and pinpoint desirable and undesirable child behaviors Teach expectations for behaviors Provide consistent positive reinforcement for desired behavior Provide consistent and moderate consequences for undesired behaviors
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Academic support skills (grades 2-3) Initiate conversation with teachers about children’s learning Help children develop reading and math skills Create a home environment supportive of learning
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Skills to reduce risks for drug use (grades 5-6) Establish a family policy on drug use Practice refusal skills with children Use self-control skills to reduce family conflict Create new opportunities in the family for children to contribute and learn
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SSDP Interventions: Child Skill Development Intervention Component Child social and emotional skill development
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Skill Area Interpersona l problem solving skills (grade 1) Refusal skills (grade 6) Specific skills taught
Communication
Decision making
Negotiation
Conflict resolution
Recognize social influences to engage in problem behaviors
Identify consequences of problem behaviors
Generate and suggest alternatives
Invite peer(s) to join in alternatives
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Effects of SSDP Intervention on School Bonding from Age 13 to 18 3.1
3 2.9
2.8
Full Treatment Late Treatment Control 2.7
13 14
Hawkins, Guo, Hill, Battin-Pearson & Abbott (2001)
15 Age 16 17 18
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SSDP Intervention Effects Compared to Controls
At the end of the 2 • boys • girls less self-destructive Grade Age 1 7 Late Tx Full Intervention Control 2 3 8 less aggressive 9 nd grade By the start of 5 th grade, those in the full intervention had • less initiation of alcohol • less initiation of delinquency • better family management • better family communication • better family involvement • higher attachment to family • higher school rewards • higher school bonding Late Tx Full Intervention Control 4 5 6 7 8 9 10 11 12 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 39
SSDP Intervention Effects Compared to Controls
By age 18 Youths in the Full Intervention had
less heavy alcohol use: less lifetime violence : less lifetime sexual activity: fewer lifetime sex partners: less grade repetition: 25.0% 59.7% 83.0% 61.5% 22.8% Control vs. 15.4% Control vs. 48.3% Control vs. 72.1% Control vs. 49.7% Control vs. 14.0% Full Full Full Full Full Grade 1 Age 7 Late Tx Full Intervention Control 2 3 8 9 Late Tx Full Intervention Control 4 5 6 7 8 9 10 11 12 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 40
SSDP Intervention Effects Compared to Controls
By age 21, full intervention group had: More high school graduates: More attending college: Fewer selling drugs: Fewer with a criminal record: More singles using condoms: 81% Control vs.
6% Control vs.
13% Control vs.
53% Control vs.
44% Control vs. 91% 14% 4% Full 42% Full 60% Full Full Full Grade 1 Age 7 Late Tx Full Intervention Control 2 3 8 9 Late Tx Full Intervention Control 4 5 6 7 8 9 10 11 12 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 41
Seattle Social Development Project
Effects by Age
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High School Graduate 100% 75% 50% 25% 81% 86% 91%* Control Late Full 0%
*p< .05
Audio note: Audio for main lecture ends here. Q&A session audio is on last slide in presentation.
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SSDP intervention had specific benefits for females and African Americans by age 21 Females
Lifetime Births Control 40% Full 23%
African Americans
Lifetime STD’s Control 34% Full 7% (Lonczak et al., 2002) Grade 1 Age 7 Late Tx Full Intervention Control 2 3 8 9 Late Tx Full Intervention Control 4 5 6 7 8 9 10 11 12 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 43
Conclusion
Parents and teachers in the elementary years can make a difference that lasts into adulthood. Increasing opportunities, skills and recognition for children in the elementary grades can put children on a positive developmental path.
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Benefits and Costs of Prevention and Early Intervention Programs for Youth
Steve Aos, Associate Director
Washington State Institute for Public Policy Phone: (360) 586-2768 E-mail: [email protected]
Institute Publications: www.wa.gov/wsipp 45
Examples
Summary of Benefits and Costs (2003 Dollars ) Dollars Per Youth (PV lifecycle) Benefits Costs B C
Early Childhood Education Guiding Good Choices $ 17,202 $ 7,605 Life Skills Training $ 746 Seattle Social Development $14,246 Intensive Juv. Supervision $ 0 $7,301 $ 687 $ 29 $ 4,590 $ 9,901 $6,918 $ 717 $9,837 $ 1,482 -$1,482
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But…
Prevention approaches that do not work or have not been evaluated are more widely used than those shown to be effective.
(Gottfredson & Gottfredson, 2002, Hallfors et al 2001, Ringwalt et al., 2002.)
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Effectiveness and Dissemination Trials are Needed
We have reached a stage where interventions need to be evaluated in real world settings and research needs to be conducted on how to effectively disseminate empirically supported policies and programs.
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Dissemination Requires Capacity
Published material including manuals, guides, curricula. Certification of trainers.
High quality, readily available technical assistance.
Dissemination organization committed to distribution and delivery of tested program.
Data monitoring system to provide feedback on implementation fidelity and outcomes.
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Effective Dissemination Requires Implementation Fidelity and Methods to Measure It.
Program Definition Adherence Dosage / exposure Quality Participant responsiveness 50
Population monitoring of risk, protection and drug use outcomes is important
Ongoing monitoring of well-being, problem behavior, and risk and protective factors for problems is an essential practice for guiding prevention efforts and ensuring they achieve effects.
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Why Community Level Monitoring?
Different communities and neighborhoods have different profiles of risk and protection.
Community levels of risk and protection predict community levels of youth drug use, achievement test passage, and other outcomes.
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Total Aggregated Risk Factors in Different Neighborhoods of a City Neighborh oo d #2 In su f fic ie nt n um b e r of st u de n ts in th is are a.
No s tu d en ts in t his a re a
.
Neighborh oo d #1 Neighborh oo d #3 John A. Pollard , P h.D. Dev elopm ental Res earch and Pr ogram s
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100% 90% 80% 70% 60% 50% 40% 30% Community Family
Survey Participation Rate 2002: 87.4%
Risk Profile 8 th 2002 Grade School Peer-Individual 20% 10% 0%
Lo w N eig hb orh La oo Co ws d A mm an tta un d N ch ity orm me D s F nt iso rga av Pe niz ora ati ble rce on to ive Pe D d A rug rce va ive U se ilab d A ility va of ilab Dr ility ug Po s of Ha or F nd am gu ily M Pa Fa ns an mi ren ly H tal ag em isto Att Pa en Fa itu ren t mi ry o de tal ly C f A s F Att on nti av itu flic so ora de t cia ble s F l B To av eh wa ora av ior rds ble D to rug An U tis se oc ial Be ha Ac Lo ad vio r em w C ic F om mi ail tm ure en t to Sc ho Re Fa be Ea ol vo llio rly Pr rab us ne ob Ea le A ss lem rly ttitu In Be de itia ha tio s T Fa vio n o ow vo r f D ard rab rug An le A Us tis oc ttitu e ial Lo de Be s T w P ha ow erc vio ard eiv r D ed rug R U isk se s o f D Fri rug en Us ds ' U e Re se of wa Se Dr rds ns ug fo ati s r A on nti S so ee cia
School 2002
kin g l In vo lve me nt Ov era ll R isk
District 2002 Estimated National Value
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100% 90% 80% 70% 60% 50% 40% 30% Community Family
Survey Participation Rate 2002: 79.7%
Risk Profile 10 th 2002 Grade School Peer-Individual Peer-Individual 20% 10% 0%
Lo w N eig hb orh La oo Co ws d A mm an tta un d N ch ity orm me D s F nt iso rga av Pe niz ora ati ble rce on to ive Pe D d A rug rce va ive U se ilab d A ility va of ilab Dr ility ug Po s of Ha or F nd am gu ily M Pa Fa ns an mi ren ly H tal ag em isto Att Pa en Fa itu ren t mi ry o de tal ly C f A s F Att on nti av itu flic so ora de t cia ble s F l B To av eh wa ora av ior rds ble D to rug An U tis se oc ial Be **A ha ca Lo vio de w C r mi c F om mi ailu tm re en t to Sc ho Re Fa be Ea ol vo llio rly Pr rab us ne ob Ea le A ss lem rly ttitu In Be de itia ha tio s T Fa vio n o ow vo r f D ard rab rug An le A Us tis oc ttitu e ial Lo de Be s T w P ha ow erc vio ard eiv r D ed rug R U isk se s o f D Fri rug en Us ds ' U e Re se of wa Se Dr rds ns ug fo ati s r A on nti S so ee
School 2002
kin cia g l In vo lve me nt Ov era ll R isk
District 2002 Estimated National Value
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The Challenge for Community Prevention
To identify and address those risk factors that are most prevalent and those protective factors that are most depressed in the community with tested effective policies and programs.
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Society for Prevention Research
16th Annual Meeting: SAN FRANCISCO May 28-30, 2008 Information: www.preventionresearch.org
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From Practice Wisdom to Prevention Science: Advances in Preventing Drug Abuse among Young People
QUESTION AND ANSWER SESSION (second hour of class) J. David Hawkins Ph.D.
Endowed Professor of Prevention Social Development Research Group School of Social Work University of Washington www.sdrg.org
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