EVALUATING EVIDENCE-BASED SUBSTANCE ABUSE CURRICULUM FOR
USE OR NEW PROGRAM DEVELOPMENT FOR AN ALTERNATIVE HIGH
SCHOOL SETTING
Valerie Rodgers
B.A., Bethel College, 1998
PROJECT
Submitted in partial satisfaction of
the requirements for the degree of
MASTER OF SOCIAL WORK
at
CALIFORNIA STATE UNIVERSITY, SACRAMENTO
SPRING
2011
EVALUATING EVIDENCE-BASED SUBSTANCE ABUSE CURRICULUM FOR
USE OR NEW PROGRAM DEVELOPMENT FOR AN ALTERNATIVE HIGH
SCHOOL SETTING
A Project
by
Valerie Rodgers
Approved by:
__________________________________, Committee Chair
Santos Torres, Jr., Ed. D.
____________________________
Date
ii
Student: Valerie Rodgers
I certify that this student has met the requirements for format contained in the University
format manual, and that this project is suitable for shelving in the Library and credit is to
be awarded for the Project.
__________________________, Graduate Coordinator
Teiahsha Bankhead, Ph.D., LCSW
Division of Social Work
iii
________________
Date
Abstract
of
EVALUATING EVIDENCE-BASED SUBSTANCE ABUSE CURRICULUM FOR
USE OR NEW PROGRAM DEVELOPMENT FOR AN ALTERNATIVE HIGH
SCHOOL SETTING
by
Valerie Rodgers
There is a need for a cost-conscious effective substance abuse program for use in an
alternative high school substance abuse class.
The writer chose the following four curriculums listed on the National Registry of
Evidence Proven Practices and evaluated research and available program information in
consideration for implementation in the desired setting:
Life Skills Training,
Multisystemic Therapy, Motivational Interviewing, and Project SUCCESS .
Efficacy in regards to use in the desired setting is largely not proven, but the programs
evaluated were promising for possible implementation, or for use in the creation of a new
curriculum.
_______________________, Committee Chair
Santos Torres, Jr., Ed. D.
_______________________
Date
iv
DEDICATION
I would like to express my deepest thanks to my family in supporting me in my current
educational endeavors. Mom and Dad, you were very different but great examples of how
to serve others in every day life. Mom, thank you for your support and encouragement
through this. Dan, thank you for putting up with me, encouraging me, and enabling me to
pursue my dream, especially through trying times. Whitney, thank you for letting me
steal your idea of getting a Master’s Degree in Social Work. You are inspiring in your
desire to serve others as well! Olivia, thank you for your energetic and adventurous spirit.
You are such an inspiration to me! I am sure you will someday choose to use your gifts to
better the world. (Right now you already do this without knowing it).
v
TABLE OF CONTENTS
Page
Dedication ..................................................................................................................... v
Chapter
1. PROBLEM STATEMENT AND OVERVIEW ..................................................... 1
Introduction .......................................................................................................1
Background of the Problem ............................................................................. 3
Statement of the Problem .................................................................................. 4
Purpose of the Study .........................................................................................4
Theoretical Framework .....................................................................................5
Definition of Terms............................................................................................8
Assumptions...................................................................................................... 8
Justification ...................................................................................................... 9
Limitations ....................................................................................................... 9
2. REVIEW OF THE LITERATURE ...................................................................... 10
Background ................................................................................................... 10
Criticisms of the So-Called Evidence ............................................................. 13
Trends in AOD Use by Adolescents ............................................................... 14
Curriculum Defined ........................................................................................ 16
California Curriculum Standards .................................................................... 16
Education Codes Relevant to Substance Abuse Curriculum .......................... 21
3. METHODS .......................................................................................................... 27
4. THE PROJECT .................................................................................................... 29
General Findings in This Research ................................................................. 29
Curriculum Evaluated Further for Use in a Continuation High School
Setting ............................................................................................................. 34
5.
SUMMARY, CONCLUSIONS AND IMPLICATONS ......................................46
What Can be Learned From the Limited Research of the Curriculum Not
Considered for Implementation? .................................................................... 47
vi
Considerations Regarding the Evaluated Programs for Possible Implementation
......................................................................................................................... 48
Recommendations in Selecting or Creating Curriculum Based on These Findings
......................................................................................................................... 50
References ................................................................................................................. 51
vii
1
Chapter 1
PROBLEM STATEMENT AND OVERVIEW
Introduction
This project was created to examine available substance abuse programs in order
to look for the best program for implementation in an alternative high school setting, and
to identify best practices of the selected curriculums for possible curriculum creation
based on those results.
In creating this project, the writer sought to examine current evidence-based
curriculum available for implementation in alternative high school settings. As this writer
helped implement a course on substance abuse in an alternative high school setting, she
was interested in the curriculums currently available, and wondered about their
theoretical frameworks, efficacy, efficiency, measures of success, costs, best practices
and the implementation process. This project examined curriculum, and the specific
requirements of substance abuse curriculum used in California public schools. This
project aimed to shed light on the evidence-based curriculums available. This project
considered which curriculums could be most likely employed of the available curriculum
for settings such as the writer’s previous experience, and explored the implementation
and results of these specific programs.
In the writer’s experience at a continuation high school, students who tested
positive for alcohol or drugs were mandated to participate in a substance abuse recovery
class as one of the conditions to continue enrollment in their current school setting. There
2
were also some students who voluntarily participated in the substance abuse class to
further their engagement in their own recovery process.
This project is the examination of possible applicable curriculum for use in the
continuation high school setting, based on the author’s experiences, available literature
and the perceived curricular needs of the continuation high school.
Curriculums for an environment such as the one mentioned must address students
with a wide range of using habits or histories, from students who may have used few
times and were found out by authorities, to students who define themselves as “addicts.”
The substance abuse class the writer was involved in for two grading periods
during the fall of 2010 was co-facilitated by a teacher, and occasionally by other graduate
students. Discussion worksheets and classroom handouts were available, but not as an
organized and easy-to-use curriculum. Group class discussion was also an aspect of this
course. Ways to address more fundamental issues that may contribute to substance use or
abuse were some of the areas not addressed in the worksheets and handouts. Some topics
were difficult to cover due to students’ sense of a lack of safety of personal information,
although there were guidelines that included maintaining confidentiality.
The writer wanted to make the class easier to facilitate for the staff and graduate
students: to have a set curriculum and expectations, with comprehensive information, that
will be engaging and encouraging to the high school students. The author also desired to
prevent or change the defensive attitudes of students in this setting, as observed in many
of the students in the classes in which she participated. The social work student became
interested in the evaluation of available curriculum to learn about what is currently in use,
3
what works and what doesn’t, and what best practices these curriculum have to offer in
future curriculum development and implementation.
People commonly hold that the purpose of our education system is simply “to
educate.” Adelman and Taylor in Mental Health in Schools say the duties of education
professionals also include “promoting positive well-being and minimizing the scope of
mental health and other health problems” (2010a, p. 9). This includes dealing with
barriers to learning and healthy development. A common problem interfering with
students’ educational attainment and achievement among high schools students is alcohol
and substance use, misuse, and abuse.
Background of the Problem
Alcohol and substance abuse among teenagers is a prevalent problem. Based on
the average of 2006 to 2007 survey results, about 10% of teens in California use illicit
substances and/or alcohol in any month (SAMHSA,
http://oas.samhsa.gov/2k7State/California.htm ). While even SAMHSA acknowledges
that some substance use in “technically normative” during adolescence, substance use
and abuse are huge problems (Winters, 1998, p. 5). Delinquency, violence, homicides
and suicides, accidents are associated with substance abuse, as we all as injuries,
accidents, risky sexual behaviors, and psychiatric disorders are all associated with
substance abuse (Winters, 1998, p. 2). More general problems, noted in this reference as
associated with drinking include excessive calorie intake, sleep issues, appearing older,
The financial burden substance abuse places on society is considered quite high.
4
Continuation high schools are part of the educational options in schooling in
California (California Department of Education, 1995). Students at a continuation high
school have often have been labeled “at-risk” and have left the comprehensive high
school setting due to substance abuse, legal issues, lack of academic credits, behavioral
problems, academic challenges, and/or childcare needs.
The report “Youth substance use interventions: Where do they fit in a school’s
mission?” (2010) informs readers that substance abuse is commonly accompanied by
poor academics, violence, and “other forms of negative activity” (Adelman & Taylor,
2010b, p.5). Substance abuse is also associated with unlawful activities, risky sexual
behaviors, trauma of a physical, sexual or psychological nature, accidents, and dropouts
(Adelman & Taylor, 2010b, p 3). Any or all of these reasons can disrupt a student’s
educational achievement, and make substance use, misuse or abuse a problem that affects
education.
Statement of the Problem
There is a need for an effective affordable alternative high school substance abuse
curriculum that could be implemented easily.
Purpose of the Study
This project was created to examine available substance abuse programs in order
to look for the best program for implementation in an alternative high school setting, and
to identify best practices of those curriculum for possible curriculum creation based on
those results.
5
Theoretical Framework
The existence of a “substance abuse” class speaks to the nature of all things that
are aimed to address a specific problem: they are problem-based and problem-focused.
They involve finding, diagnosing and treating problems (Clark, 1998). This focus on
problems aims much attention on how an individual got into a situation, the causation,
often making the problem more complex in an in-depth examination. Further exploration
of these lines of thinking can bring up past events and unconscious issues within the
individual. These problem-based discourses could lead to never-ending exploration of
what happened in the past, and rumination on “what it all means” without ever getting to
a place of change or a focus on the future.
In contrast to the problem-based methods commonly used in the past “Treatment
models that focus primarily on client strengths and competencies (sic) have made a
significant impact on the field of substance abuse treatment in the past 20 years”
(McCollum, Trepper, & Smock, 2003, p. 28).
The strengths perspective is found in or intersects with numerous other theories
and perspectives, including solution-focused therapy, transpersonal perspective, positive
psychology, empowerment framework, and narrative therapy.
This perspective utilizes techniques of solution-focused therapy (Clark, 1998).
Solution-focused therapy, as found in the strengths perspective, recognizes the client as
having the resources and abilities to resolve their own problems (Daki & Savage, 2010).
Strengths perspective has some alignment with the transpersonal perspective as having a
large focus on the strengths of the individual, according to Moxley & Washington (2001).
6
Transpersonal theory seeks to aid individuals in fulfillment, considers the whole person,
and looks at the person in relation to all other individuals and things (Canda, 2006).
Strengths perspective has some overlap with positive psychology, with its emphasis on
character virtues and individual strengths (Martin, Seligman, Steen, Park & Peterson,
2005; Park & Peterson, 2008). The strengths perspective incorporates the strengths and
capacities that are also recognized by the empowerment approach (Guo & Tsui, 2010).
Seligman and Csikszentmihalyi said that on the individual level positive psychology is
about an individual’s positive traits (2000). Problems can be externalized in strengthsbased work, as in Michael Clark’s example of “He steals things” instead of “He is a
thief,” a technique commonly used in narrative therapy (1998, p. 48).
The strengths-based approach focuses largely on identifying, developing, and
utilizing strengths and abilities. It is goal-oriented and resolution-focused. It also
promotes lifelong learning; that an individual can pursue lifelong growth of knowledge
and skills. According to Seligman and Csikszentmihalyi, prevention efforts that stress
building competencies such as these have proven effective (2000). The strengths-based
practitioner working in substance abuse must similarly help people find their strengths
and realize how to use them as tools for achieving recovery (Rapp, 1997 as cited in
Moxley &Washington, 2001).
A strengths-based focus is embraced in aspects of education and substance abuse.
In “Youth Substance Use and Interventions: Where do they fit in school’s mission?”
(2010) Adelman and Taylor note an important influence the strengths-based perspective
has on educational standards (2010). Likewise, Michael Clark writes of the field of
7
education’s embracing of a strengths-perspective through its focus on self-esteem
building and resilience (1998). According to Moxley and Washington in their article
“Strengths-based recovery practice in chemical dependency: A transpersonal perspective”
(2001) there are many advantages in using strengths perspective with people affected by
chemical dependency (2001). It offers alternatives to the common deficit-focused
medical model’s practice of labeling problems, stigmatizing people, and leaving them
feeling helplessly trapped at the will of the so-called problem stories of their lives. In the
common medical model and other problem-focused perspectives, they leave the helper
tied into treating the problem in a prescribed manner, ignoring the contextual elements of
the individual’s life. The strengths-based practitioner will help clients find their strengths
within any situation, and to overcome the labels placed on them by society and the
psychological community (Saleebey, 1997).
Bertolino says of the strengths perspective: “ When cultivated, activated and
integrated with new experiences, understandings, ideas, and skills, these strengths help
people to reduce pain and suffering, resolve concerns and conflicts, and cope more
effectively with life stressors (sic) higher levels of relational and social functioning”
(Bertolino, 2010, p. 12).
The strengths perspective is not primarily to establish a positive relationship with
the helping professional (Clark, 1998). Strengths-based work is not intended to ignore
real problems that people experience (Saleebey, 1996). The strengths perspective is not
excusing an individual from any responsibility they may hold, but it is enlarging the
person’s chances to change, grow, make new choices, and redefine who they are and who
8
they will be from this point forward. The strengths-based approach is noted by Michael
Clark as still holding teens accountable (1998). This approach holds that change is
possible and expected, making individuals responsible for their own decisions and
actions.
Definition of Terms
Abuse refers to regular use of a substance
Addiction/Dependence refers to regular use of a substance with physical or social
consequences
AOD refers to Alcohol or Other Drugs
Curriculum/ Program, as used in this project, refer to a planned approach and/or activities
undertaken to address a topic
Misuse refers to use of a substance other than as intended, or use with possible negative
physical or social consequences
SAMHSA refers to the Substance Abuse and Mental Health Services Administration
Substance refers to any substance used
Theory/Framework/Perspective refer to the ideas on which therapeutic approaches,
programs or curriculums are founded
Assumptions
This project will assume the need for a substance abuse class as a valid way to
address substance abuse with high school students.
Justification
This project addresses the curriculum needs of a substance abuse class in an
9
alternative high school. Those who will benefit from this project are those searching for
curriculum or creators of curriculum who can learn about available approaches, their
implementation and efficacy in consideration of their own ideas for a new curriculum.
Limitations
This project will not explore the question of whether a class should be used in a high
school setting to address problems of substance abuse.
This project will not consider what students should participate in a substance abuse
class, and will assume that school districts have their own determinations of this.
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Chapter 2
REVIEW OF THE LITERATURE
Background
No Child Left Behind requires that schools implement substance abuse programs
that have proven efficacy (U.S. Department of Education, 2002).
In selecting curriculum evaluators are expected to find evidence-proven programs
likely to be effective with their student’s demographics (Sobeck, Abbey & Agius, 2006).
Critical review should be used to examine the possible curriculums, considering program
goals and features. A theoretical agreement on how change occurs is needed between the
curriculum and the participants. Program fidelity is dependent on using all of the
curriculums components, properly trained staff, and organizational support in the
implementation of the program.
According to SAMHSA’s “Treatment of adolescents with substance use
disorders” general components of treatment programs that could be used in an alternative
high school setting include an orientation to the treatment approach, peer monitoring for
participants to positively influence each other, conflict resolution, and client contracts
(Winters, 1998). Treatment should include treatment planning for each participant. This
would involve acknowledging the circumstances and influences in the participant’s life,
setting attainable goals and objectives, identifying strengths and resources, identifying
possible treatment strategies that might be beneficial, and identifying other needed
supports available to the participant through the community.
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Over half of the public school districts in the United States implement a substance
use prevention program within their districts (Ringwalt, et al., 2008).
According to SAMHSA, treatment should address the distinctive needs of each
participant. Treatment should consider the participant’s involvement with the juvenile
justice system and drug court, housing or potential homelessness, sexuality and gender
identity, and coexisting disorders (Winters, 1998). Those providing treatment should also
be aware of applicable state laws, particularly regarding consent and privacy and
confidentiality. Procedures should be in place to properly disclose issues regarding the
process for disclosure of information, and what to do in case of suspected abuse, neglect,
or possible harm to self or others.
According to Gorman, drug prevention programs have been implemented in
schools for decades (2003). In the sixties and seventies programs focused on providing
factual information. However, early programs were found to have negative effects, and in
1973 a moratorium was recommended on prevention programs in schools. In the
eighties, program developers began using the social influence approach, from “social
learning theory and problem behavior theory” (2003, p. 1087). These programs were
found to be effective in prevention, but were not implemented until the nineties, when
those providing funding began to demand that the programs were evidence-based.
Started in 1983, a common and well known approach to substance abuse
prevention and in schools is the DARE program. (Skager, 2007). DARE, Drug Abuse
Resistance Education, is sponsored by police and delivered by specially trained officers
to children in kindergarten through twelfth grade. DARE’s website claims that DARE
12
programs are implemented in 75% of schools in the United States, and in 43 countries
(http://www.dare.org/home/about_dare.asp Retrieved December 20, 2010). The website
claims that DARE is “science based” and meets “standards,”
(http://www.dare.org/home/Resources/Default5647.asp?N=Resources&M=16&S=0
Retrieved December 20, 2010). Skager claimed that independent evaluations of DARE
programming concluded that DARE is found to have no effect on alcohol or drug use,
and in some cases may increase use (2007). DARE has made efforts toward proving
efficacy of its programs. Gorman and Huber reanalyzed DARE results and found some
measurable effects on drug prevention, enough to meet the minimum qualifications to be
called “evidence-based” (2009). The DARE website specifically notes its “keepin’ it
REAL” middle school curriculum as an “evidence-based” program recognized by
SAMHSA (http://www.dare.org/officers/Curriculum/Default66d2.asp Retrieved
December 20, 2010).
Today there are many curriculums available to address substance abuse
prevention and serve as interventions. Current substance abuse curriculums are
commonly based on dissemination of information and the use of cognitive-behavioral
techniques (Rones & Hoagwood, 2000).
There are a variety of substance abuse curriculums available via SAMHSA’s
National Registry of Evidence-based Programs and Practices at
http://www.nrepp.samhsa.gov/Search.aspx . This website provides over 160
interventions regarding mental health and substance abuse. Information provided on each
intervention includes age and race recommendations, links to related websites, and
13
potential costs. These interventions have been declared evidence-based through the
review of the research listed for each individual program.
Evidence-based prevention programs began receiving funding through the Safe
and Drug Free Schools and Communities Act in 1988 (Skager, 2007). Evidence-based
programs became required under the Safe and Drug-Free Schools and Communities
program of the US Department of Education in 2001 (Gandhi, Murphy-Graham,
Petrosino, Schwartz & Weiss, 2010). Any programs funded by the US Department of
Education must meet the criteria of its “principle of effectiveness,” which a year later
became part of the No Child Left Behind requirements. The US Department of Education
posted its List of Exemplary and Promising Prevention Programs, offering programs that
were considered “exemplary” or “promising” in attaining the principles of effectiveness.
Other “evidence-based” program lists have been made available through other
organizations such as the SAMHSA list and the National Institute of Drug Abuse.
While there are some curriculums aimed at specific substances, many cover
multiple substances together. In a study from Werch, Moore, Diclimente, Own, Carlson,
& Jobli, it was found that the impact was greater in the single substance intervention
(2005). This report also suggested an increase in use among individuals that had already
used a substance before they participated in intervention activities.
Criticisms of the So-Called Evidence
Gorman evaluated many of the research practices of the school-based programs
and concluded that their “science” was faulty, not meeting the rigorous standards of
research (2003). Sobeck, Abbey and Agius, conducted a five-year study that used a
14
holistic evidence-based program, but did not produce the effects expected (2006). These
authors concluded that proper implementation of a program is challenging due to
improper selection of a curriculum and due to all the varying goals of stakeholders.
Gandhi, Murphy-Graham, Petrosino, Schwartz, and Weiss, found that there is
scant evidence that programs declared “evidence-based” have any substantial impact
(2007). They found that few studies had any noted long term impact. Many program
evaluations were done by the program developers themselves, bringing up questions of
ethical concerns and validity. Poor designs of the studies, particularly their randomization
practices, were noted as a potential issue in considering the legitimacy of many studies.
Some of the studies showed programs as “harmful for particular groups;” in particular,
students labeled as substance “users” whose use may have increased due to program
participation (2007, p. 62). Some studies found that groups led by peers were more
effective, and groups led by teachers were as effective, or less effective.
Trends in AOD Use by Adolescents
The results of the California Student Survey (CSS) show a plateauing of AOD use
among the ninth and eleventh grade students around 2005, remaining similar for the
2007-2008 results http://www.wested.org/online_pubs/hhdp/css_12th_highlights.pdf
For individuals age 12 to 17, the NHSDA survey data for 2007 found that about
7.7% had were “dependent on or abused illicit drugs or alcohol” (2010b, 3).
The 2009 National Survey on Drug Use and Health, conducted by SAMHSA,
released by the Office of National Drug Control Policy on September 16, 2010 depicts
the prevalence of and recent increases in misuse of pain relievers, marijuana,
15
methamphetamine and MDMA by Americans twelve years of age and older. A decrease
in cocaine use was reported. Use of any illicit drug was projected by this study as being
used by 21.8 million Americans, 8.7% of the American population.
Adelman and Taylor interpret the overall data of recent surveys on adolescent
AOD use and abuse to indicate that while many youth experiment with illicit drugs, few
will progress into an addiction (2010b). Adelman and Taylor recommend understanding
the determining factors in the reasons for use; whether for internal factors, or
environmental ones (2010b). Purely internal factors as the causes are considered rare, as
most factors influencing use and abuse are environmental, or a mixture of both
environmental and internal. Adelman and Taylor suggest creating treatments to address
the broad range of causes. They cite the Center for Substance Abuse Prevention that the
more risk factors “at play, the less likely it is that an accumulated set of protective factors
can counteract their impact” (2010b, p. 10). They recommend connecting school
approaches with the community and linking resources as more than part of a system of
care, bust as part of “a full continuum of systemic interventions by weaving together the
resources of school, community/home” (p. 16). They stress the need to address the roles
and influence that family, friends, and school climate play on use and abuse for each
individual (p. 12). They state “multifaceted problems usually require comprehensive,
integrated solutions applied concurrently and over time” (p. 16). They recommend
adopting an evidence-based approach, but specify that an intervention should fit the
needs of the school and students, and that implementation problems may exist in those
16
“evidence-based” approaches and may claim evidence found in highly controlled studies
instead of real-world settings (2010a & 2010b).
Curriculum Defined
“Curriculum” has a few definitions. It most often refers to the content covered in
a particular class. It is also defined as “a course of study” or “the content and methods a
teacher uses to plan and conduct his or her class” (Frey, Fisher & Moore, 2005, p. 4).
Frey, Fisher and Moore discuss the current efforts to improve education on a
national and state level, as evidenced through the establishment of standards-based
education (2005). These standards set the benchmarks for work at the different grade
levels, on which curriculum should be based. Standards-based reform aims to get each
child in a grade level to master the same material. Three types of skills are associated
with learning: social skills, knowledge, and communication skills.
According to Frey, Fisher and Moore, curriculum should try to address all the
varieties of intelligences and learning styles (2005). While written materials offer facts,
the information must be put into context, and be presented in varying ways so there are
more chances to absorb and learn. Activities should build upon previous material
covered. These authors also suggested the use of supplemental materials and activities
include biographies, autobiographies, diaries and letters, music, websites, guest speakers,
community as the classroom (Frey, Fisher & Moore 2005, pp. 44-50).
California Curriculum Standards
The federal government can implement national framework laws for the entire
United States (U.S. Department of Education, 2005). However, the general authority of
17
educational administration falls to the states. The state is responsible for developing
curriculum standards and guidelines. Local education agencies, school districts or
singular schools select their own class content while adhering to state guidelines. The
content of a course is expected to meet the needs and characteristics of the students.
California State Board of Education’s Health Framework for California Public
Schools Kindergarten Through Grade Twelve covers the components of health education
and related programs for California’s schools (2003). Health education includes
curriculum that addresses alcohol, tobacco and other drugs.
The publication Framework for California Public Schools Kindergarten Through
Grade Twelve lists the components needed for all health education programs in order for
them to be successful (2003). Providing current and scientifically sound information,
recognizing diversity among the student population, emphasizing behavior as well as
health, presenting information in a culturally appropriate manner, emphasizing character
development, and utilizing technology as a learning tool are important parts in health
education. Also needed is a way to connect concepts to real life experiences. Effective
implementation practices in presenting the program, adequate training for staff, having
community involvement, and identifying outside resources that are noteworthy and may
be of use to students or their families are all noted components of effective health
education programs.
The Framework for California Public Schools Kindergarten Through Grade
Twelve report states that all high school students should have a minimum of one semester
of health education. “Promoting children’s health can be highly cost-effective for schools
18
and communities…disease prevention, health promotion, and access to services are
assuming greater importance in the public health agenda.” (2003, p. 10) “Prevention and
collaboration to ensure adequate access to services while avoiding duplication of services
have become fundamental components” (2003, p. 10). California State Board of
Education’s Health Framework for California Public Schools focuses on youth
development, resiliency, developmental assets, external protective factors, and internal
protective factors as important aspects in the “promotion of health and prevention of
disease among youths” (2003, p. 16).
California State Board of Education’s Health Framework for California Public
Schools lists ingredients of a “successful health education” as presenting correct, up-todate, culturally appropriate information on both health and behavior, with an emphasis on
character development and utilized technology as an enhancement of learning (2003, p.
33).
The California State Board of Education’s report, on page 41, addresses
categorical funding that is used for health education programs. The Center for Disease
Control’s Division of Adolescent Health studied prevention programs and identified
criteria of “curricula that provided credible evidence of effectiveness…called ‘Programs
That Work’ “ and came up with the following criteria, as well as criteria related to studies
on implementation and effectiveness, follow-up measures, and publication. The criteria
applicable in our intended setting, at this creation stage of the curriculum, as listed on
page 41:
19
“The intervention was a complete curricular program or package, not just a single
component, such as a video.”
“The intervention involved a classroom or other group setting.”
“Content areas were specific to the program’s health focus (e.g., tobacco-use
prevention or STD prevention).”
“The curriculum could be used by the average teacher with appropriate training.”
Page 42 lists curriculum criteria based on California Department of Education’s
Getting Results report (N.D.). They list criteria for “the selection of an effective,
research-based health curriculum or program” based on research conducted during
implementation of the program. This curriculum will have to be evaluated using these
criteria in the future.
The California State Board of Education’s results of research used in creating
their standards found that unhealthy behavior is not a result of ignorance, but is related to
personal skills (2003). They note research from Baranowski, Perry and Parcel, as well as
other sources, that have found that positive behavior is associated with programs that
include “personal and social skills development” (p. 43). They also cite Bandura and
other’s use of the environmental (“social influences”) model, which “recognizes and
emphasizes the social environment as a critical factor in shaping health behavior.
Influences such as the family, school, the faith community, cultural contexts, peer
behavior, and media are of great importance” (p. 43). The intrapersonal and
interpersonal skills of students need to be addressed through “analysis of media
20
messages, decision making, coping strategies, assertiveness, refusal skills, validation of
perceived social norms, and resolution of conflicts” (p. 43).
The Framework for California Public Schools Kindergarten Through Grade
Twelve notes that consideration should be given to matching the right curriculum to the
intended school district’s needs (2003). Programs can also vary within a district. Clearly,
any school can choose its own curriculum, seek curriculum that meets its needs,
addresses the community’s diversity, and other relevant issues. Curriculum needs to meet
Education Codes.
According to the California State Board of Education on page 216, assessment of
a student’s progress and learning in a health program should measure the following:
Accepting personal responsibility for lifelong health.
Respecting and promoting the health of others.
Understanding the process of growth and development.
Becoming informed users of health-related information, products, and services.
Assessments of learning should not just be for giving grades, but also to evaluate
the program and its implementation according to Framework for California Public
Schools Kindergarten Through Grade Twelve(2003). Assessment should consider the
four areas mentioned above, as well as behaviors and attitudes about health. It is
recommended that assessments be part of class work, not a separate test given in class
time. Examples of ways to do this applicable in a substance abuse-related course include
self-assessments, developing long-term goals, working on positive social skills in group
assignments, role-playing or other decision-making skills through sample scenarios,
21
journaling, school wide surveys (with the required parental permission as required by Ed.
Code 51513), student-produced media for promotion of healthy behaviors, and student
portfolios showing the student’s knowledge and skills gained.
Education Codes Relevant to Substance Abuse Curriculum:
ED 51880-51881.5 Comprehensive Health Act of 1977
http://www.leginfo.ca.gov/cgi-bin/displaycode?section=edc&group=5100152000&file=51880-51881.5 (Retrieved January 16, 2011).
ED 51890-51891 comprehensive health education definitions
http://www.leginfo.ca.gov/cgi-bin/displaycode?section=edc&group=5100152000&file=51890-51891 (Retrieved January 16, 2011).
ED 51900-51901 Department of Education: responsible for guidelines; functions
of http://www.leginfo.ca.gov/cgi-bin/displaycode?section=edc&group=5100152000&file=51900-51901 (Retrieved January 16, 2011).
ED 51911-51915 comprehensive health education http://www.leginfo.ca.gov/cgibin/displaycode?section=edc&group=51001-52000&file=51911-51915
(Retrieved January 16, 2011).
ED 51202 courses of study, includes “effects of alcohol, narcotics, drugs”
http://www.leginfo.ca.gov/cgi-bin/displaycode?section=edc&group=5100152000&file=51200-51206 (Retrieved January 16, 2011).
ED 51203 substances and effects; refers to HSC 11032
http://www.leginfo.ca.gov/cgi-bin/displaycode?section=edc&group=5100152000&file=51200-51206 (Retrieved January 16, 2011).
22
ED 51260-51269 drug education http://www.leginfo.ca.gov/cgibin/displaycode?section=edc&group=51001-52000&file=51260-51269
(Retrieved January 16, 2011).
ED 60040-60052 issues to consider for adoption of instructional materials (things
to address at the creation stage, if possible) http://www.leginfo.ca.gov/cgibin/displaycode?section=edc&group=60001-61000&file=60040-60052
(Retrieved January 16, 2011).
HSC 11032 part of the Uniform Controlled Substance Act (11000-11033)
http://www.leginfo.ca.gov/cgi-bin/displaycode?section=hsc&group=1000111000&file=11000-11033 (Retrieved January 16, 2011).
HSC 11082 concerning county alcohol and drug abuse prevention funds; includes
criteria for receipt of funds in schools http://www.leginfo.ca.gov/cgibin/displaycode?section=hsc&group=11001-12000&file=11800-11802 (Retrieved
January 16, 2011).
Community involvement is an expected component in the curriculum creation and
implementation (California State Department of Education, 2003). Potential sources for
involvement through guest speakers include Alcoholics Anonymous, Narcotics
Anonymous, The Effort and other local or regional treatment resources. Sources for
treatment in places of faith should also be mentioned as an option in external resources.
Information for students to explore further research can include websites from SAMHSA
at www.samhsa.gov , www.freeed.gov, Office of National Drug Control Policy, National
Institute on Drug Abuse, Drug Enforcement Administration, California Department of
23
Alcohol and Drug Programs at www.adp.ca.gov , Placer County Area Substance Abuse
Services Resource Guide (Placer County Area Substance Abuse Services, 2010).
On page 59 the California State Board of Education authors discuss the “Alcohol,
Tobacco, and Other Drugs” curriculum. Curriculum is expected to cover the “full range
of prevention and intervention components” (p. 59). All types of drugs should be
covered, including tobacco, alcohol, smokeless tobacco, prescriptions and over the
counters medications, performance enhancers including steroids, as well as the effects of
secondhand smoke. Effects related to physical and cognitive health, as well as correlation
to “suicide, violence, and other health and safety issues” (p. 59). Correct use and misuse
of medications should be discussed. Pregnancy and related effects of all substances
during pregnancy should be included in the content.
The Health Framework for California Public Schools calls for resistance and
refusal skills to be worked on in the course content. This focus is contrary to some other
sources of research on effective substance abuse curriculum. Gorman found that
resistance skills training programs, a common approach to alcohol misuse, have little or
no effect on drinking behavior at research follow-up (2001). However, resistance skills
included in more comprehensive programs may not yield the same results.
The Health Framework for California Public Schools suggests an awareness of
environmental influences, social and cultural influences, and messages from society
through media should be explored to teach students how to examine these influences.
Acceptability of alcohol and tobacco use by adults is an important topic to consider.
24
Community involvement, law enforcement and agencies should be involved in the
development and promotion of curriculum.
Students should learn self-care: healthy habits, disease prevention, risk avoidance,
hygiene, developmental stages and differences, nutrition, exercise (California State Board
of Education, p. 123), self-confidence, self-esteem, build on each individual’s personal
character, appropriate use of leisure time, communication skills, recognizing and
avoiding self-destructive or harmful habits and behaviors (p.125) and building on skills to
make alternative choices, (p. 126)
The curriculum should also address understanding and acceptance of diversity (p. 125)
The Framework for California Public Schools Kindergarten Through Grade
Twelve requires the inclusion of short term and long term effects from use, effects of
combined substances, “effects on reproduction, pregnancy, and the health of children”
(2003, p. 130). This should include the effects of substances on fetal development
including when the fetus is most susceptible to issues resulting from substance abuse.
Students should continue to explore the consequences of drug use, such as the legal,
social, and economic consequences. Laws, school policies, cultural and family rules can
be discussed in the exploration of consequences, attitudes, and views on substance use,
misuse and abuse. The California State Board of Education’s authors again mention
avoidance and refusal skills on page 130. Within a curriculum they ask for the inclusion
of the physical effects, and the potential impact on self and others, as well as the
consequences and tragedies that result from drug use, including the example of date rape,
25
sexually transmitted infections through needle sharing or unsafe sexual practices,
automobile accidents, house fires, and domestic violence.
“Distinguishing between the use and misuse of prescription and nonprescription
drugs” is noted as a required component of substance abuse curriculum (California State
Board of Education, 2003, p. 130). Students need to be made aware of the resources
available in school, community, etc.
The California State Board of Education’s authors want curriculum to discuss
“the disease concept of chemical dependence” to acknowledge factors that lend to an
increased likelihood of use and dependence, but also recognize the possible “coping
strategies” that one can use in developing “positive coping strategies” (p. 131).
Under the unifying idea of “respect for and promotion of the health of others” in
the Framework for California Public Schools Kindergarten Through Grade Twelve is the
inclusion of “how to play a positive, active role in promoting the health of their families”
(p. 133). This includes choices adolescents may make that will go against the values and
standards of their family. Students should contemplate the effects alcohol, drugs and
tobacco have on families, including both long term and short term effects. One example
given by the California State Board of Education’s writers is the roles some students take
on in families, assuming the role of caregiver and provider for younger siblings due to the
incapacitation of a parent or guardian. It is also important to empower students to seek
help if alcohol or substance abuse plays a role in their families. Engaging high school
students as role models to younger children can encourage positive development (p. 122).
26
The Framework for California Public Schools Kindergarten Through Grade
Twelve calls for inclusion of discussion regarding friendships and peer relationships in
substance abuse curriculum (2003). Respecting the dignity of all people, and having the
ability to interact with diverse populations are vitally important in being able to
respectfully accept differences.
In exploring their own personal beliefs and goals,
students should consider their own behavior and its congruence or incongruence with
their values. Students should be able to understand their own responsibility in their
choices, and consider how to stand up for their beliefs and resist peers who try to steer
them in ways that are incongruent with their standards. Decision-making and problemsolving skills are expected to be stressed in curriculum, as enhancements of interpersonal
skills and relationship building.
The ability to analyze the influence and consequences of rules and laws will
enable students to consider health and safety in respect to implementation of these rules
and laws.
Due to the scope of these complex and detailed requirements listed here, the
requirements and guidelines regarding curriculum might make the selection or creation of
a substance abuse curriculum challenging. The author anticipates the need to augment
any currently existing curriculum to ensure it meets the requirements of these standards,
while still providing effective prevention and intervention regarding substance abuse and
addressing the myriad of associated problems.
27
Chapter 3
METHODS
This project will qualitatively review and evaluate articles and books related to
substance abuse curriculum for high school students. The researcher will analyze
information reported about these programs, compare results, and look for best practices
featured by these SAMHSA-approved curriculums.
This author has chosen to qualitatively examine research on effective substance
abuse programs, through reviews and evaluations of curriculum. This writer will use
research and information about evidence-based substance abuse programs aimed at high
school students listed SAMHSA’s NREPP website. The writer will utilize information on
NREPP’s website, or through the different programs’ websites to find research literature
and evaluative reviews pertaining to these curriculum. The author will look for reports of
implementation, results and efficacy. Choice of the curriculums to use will be based on
similar age range, focused specifically on substance prevention or abuse in school
settings.
To find literature related to these substance abuse curriculums, the researcher will
use information about evidence-based substance abuse programs aimed at high school
students listed by the U.S Department of Health and Human Services Substance Abuse
and Mental Health Services Administration (SAMHSA)’s National Registry of EvidenceBased Programs and Practices (NREPP) website. The writer will use this website to
generate a list of currently available curriculum. Choice of the curriculums to use will be
based on intended similar age range, focused specifically on substance prevention or
28
abuse, suburban or urban communities, intended for school settings.
The writer will utilize the information on NREPP’s website to find literature, reports
and evaluations of these programs. The researcher will analyze information reported
about these curriculums, compare results of curriculums, and look for best practices
within these curriculums through meta-analysis.
The Process of Selection and Sampling
The writer used www.nrepp.samhsa.gov to search for programs that were
designed for use with similar populations and settings. Parameters entered were:
adolescent ages 13 to 17 or young adult ages 18 to 25, substance abuse prevention,
substance abuse treatment, school, urban, suburban. Thirty-five results were listed by the
NREPP website. Some programs on the list were specified for groups or subjects not
relevant to this project’s goals: middle school, college, athletes, suicide.
The writer compiled a list of the remaining relevant curriculums, and looked at
studies relevant to the chosen curriculums and the theories and the implementation of
each one. The author considered more specific target demographics. The author
reviewed the implementation of the research and whether it was actually studied in high
schools, as well as the method of delivery. A curriculum’s adaptability to classroom use
for a six-week grading period was considered, as prescribed in the continuation high
school of reference to the author’s interests in creating this project.
29
Chapter 4
THE PROJECT
General Findings in This Research
Some of the recommended curriculums on the National Registry of Evidence
Proven Practices have little available research to back them up. Some of those
curriculums without much research seem to reflect trends in approaches to substance
abuse and other problems. Quite a few are focused more on prevention, and less on
addressing any use that may already be occurring. Some studies focus on a particular
substance, others focus on a particular demographic, and some on a particular delivery
method. These curriculums need further research, or did not meet the needs of the author
of this project, but bring to light other ideas regarding curriculum approaches to
substance abuse. For this reason the author included information on the research into the
following curriculums.
Culturally specific curriculums
Some curriculums have specifically focused on minority youth in urban settings.
These curriculums focused more on preventive aspects of substance use, but the subject
of cultural relevance seems very important to consider when creating or evaluating
programs, especially since cultural relevance was one of the recommendations listed in
the California State Board of Education’s Health Framework for California Public
Schools Kindergarten Through Grade Twelve (2003).
A study of a curriculum used specifically to address smoking prevention with
minority urban youth is discussed in the article “A skills training approach to smoking
30
prevention among Hispanic youth” (Botvin, Dusenbury, Baker, Ortiz, Kerner, 1989).
This study focused on a program of resistance skills training with Hispanic youth, and
was determined to be effective. The researchers also proved the generalizability of the
curriculum, when they found similar results of efficacy with other populations.
Another study of curriculum created for use with minority urban youth is
discussed in the article “Hip-Hop to prevent substance use and HIV among AfricanAmerican youth: a preliminary investigation” (Turner-Musa, Rhodes, Harper, &
Quinton, 2008). The study on this curriculum concluded that culturally-focused programs
can be beneficial, and found this program to have long term prevention effects.
From these two articles it seems culturally focused programs can have a positive
impact. Botvin, Dusenbury, Baker, Ortiz and Kerner’s research calls into question
whether it is necessary, as this program was generalizable to other students. No study
was found that looked at a curriculum created in two ways, one culturally specific and the
other general, to compare their efficacy with specific groups, nor does it appear that
anyone has found any other way to explore this issue further.
Technology in curriculum
Alcohol Edu is an online alcohol prevention program created in part by Mothers
Against Drunk Driving (Lovecchio, Wyatt & DeJong, 2010). Implemented by a school
for a whole grade level of students, the students complete an online course with a
baseline survey, knowledge test, and postintervention survey. While the study by
Lovecchio, Wyatt and DeJong focused on college students, the program also exists for
high schools students as detailed on the information page regarding “AlcoholEdu for
31
High School” on Inside the Classroom’s website www.outsidetheclassroom.com.
California State Board of Education’s Health Framework for California Public Schools
Kindergarten Through Grade Twelve called for implementation of technology in health
education, and clearly this program would meet that requirement (2003).
Multi-level interventions as recommended curriculums
A few examples of multilevel community-based interventions were found through
the results of NREPP’s recommended curriculum, CASASTART and Project Northland
(Murray & Belenko, 2005; Komro, Perry, Williams, Stigler, Farbakhsh, & VeblenMortenson, 2001). These types of programs focus on the students, their families, their
schools, and their communities. Community activities, mentoring, social supports, and
family services are among the components of these curriculums. These two specific
programs mentioned yielded positive results, but lacked further available research and
focused mostly on middle school age students. These might prove promising for use in
high schools as well.
Students as helpers in implementing curriculum
Mothers Against Drunk Driving’s program Protecting You/Protecting Me alcohol
prevention program utilizes high schoolers as teachers to elementary school students
regarding alcohol and automobile safety (Padget, Bell, Shamblen, & Ringwalt, 2005).
Using high school students as peer helpers was found to have an impact on the high
schoolers’ views of high levels of alcohol use, but did not change their perceptions of
lower levels of drinking.
32
Peer groups in curriculum
Reconnecting Youth is an intervention that utilizes a peer group approach with
high-risk youth (Cho, Hallfors, & Sanchez, 2005). The program was developed for use
with students who have multiple problems. It seeks to address these problems by
developing the students’ connectedness with the school and their less-troubled peers. This
approach sounded promising, but was found to be ineffective and possibly produce
negative consequences in two studies, “Efficacy vs effectiveness trial results of an
indicated ‘model’substance abuse program: implications for public health” and
“Evaluation of a high school peer group intervention for at-risk youth” (Hallfors, Cho,
Sanchez, Khatapuch, Kim, & Bauer, 2006; Cho, Hallfors & Sanchez, 2005). The
grouping of high-risk youth together was found to have negative effects on the students.
Not-on-Tobacco is a smoking cessation program of the American Lung
Association (Dino, Kamal, Horn, Kalsekar, & Fernandes, 2004; Dino, Horn, Abdulkadri,
Kalsekar & Branstetter, 2008). This program works with small groups of students to
address a myriad of issues and provides information regarding smoking. However, both
of the studies looking at this program compared Not-on-Tobacco’s ten fifty-minute
session program to brief intervention programs involving considerably less time, and
found Not-on-Tobacco to be more effective. While some impact on smoking cessation
was noted, these studies brought into question the claims of this program’s true efficacy,
as it was not measured against any comparable program of a similar length of time.
33
Sports and intervention
Project SPORT is a brief individual intervention tied in with school-related
physical activities, with a flyer mailing as a reinforcement to follow up the intervention
(Werch, Moore, DiClemente, Bledsoe, & Jobli, 2005). Studied at both middle school and
high school levels, targeting students with athletic and recreational exercise interests,
tying in substance-related issues to the overall focus on health was found to be effective
at both reducing use and increasing physical activity (Werch, Carlson, Pappas, Edgemon,
& DiClemente, 2000; Werch, Moore, DiClemente, Owen, Jobli & Bledsoe, 2003; Werch,
Moore, DiClemente, Bledsoe & Jobli, 2005). All studies of this program involved some
of the same researchers, so more research may be needed from other sources. This
approach, while promising in its use of coupling with exercise, is brief and specialized in
its approach to active youth and in its implementation practices, and would not translate
into a classroom curriculum.
Character development in curriculum
Character development is part of the focus of the Positive Action program, within
its comprehensive approach to health and academic achievement (Flay & Allred, 2003;
Ji, Segawa, Burns & Campbell, 2005). This program contains the ideas in positive
psychology, recognizing the importance in The research on this program regarding
implementation in elementary schools reported multiple areas of educational and personal
improvement (Flay & Allred, 2003; Flay, Allred & Ordway, 2001). Articles regarding
use with other age groups is not available, however NREPP’s website lists this
curriculum as applicable for children through adults, with positive outcomes on alcohol
34
and other drugs, as well as on academic and personal areas at
http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=78.
Curriculums Evaluated Further for Use in a Continuation High School Setting
This study will examine the recommended programs applicable in an alternative
education setting, and look at strengths and shortcomings of these curriculums, possible
costs and training required for implementation. Substance abuse curriculums are often
costly and require training specific to the curriculum, per exploration of curriculum listed
on SAMHSA’s NREPP website.
The writer chose to focus on four of the curriculums listed on NREPP’s website.
In comparison to the curriculum just discussed, these chosen curriculums have more
available research for the writer to evaluate their components and efficacy, and they seem
more applicable to the demographics aimed at by the writer for use in an alternative high
school setting, particularly that they are referred to as “intervention(s)” in at least some of
the research, as opposed to some of the other programs, referred to only as “prevention”
programs. These intervention programs would be more applicable with students who are
likely to already have used alcohol or other substances, as would be the indicated
participants in a substance abuse class. The chosen programs for consideration are
specifically described as applicable for use in high school settings.
Life Skills Training
The Life Skills Training (LST) intervention program combines substance abuse
knowledge with social skills. Some of the studies evaluating this program looked at it as
“prevention” while it is considered by some to be an “intervention”. This program is
35
reported to impact students’ self-efficacy and self-esteem, noted as important and
increasing the efficacy of substance abuse interventions (Wagner, Tubman & Gil, 2004).
Within its curriculum LST considers the impactfulness of one’s environment and social
influences to the use of substances, a holistic approach focusing more on all the factors
that influence substance use. This program is considered “interactive” and more effective
than non-evidence-based programs according to Ernett, Ringwalt, Thorne, Rohrbach,
Vincus, Simons-Rudolph, and Jones ((2003). Gorman and Siobhan cited LST as their
example of an effective program in the article “Prevention takes a different tack” (2001).
MacKillop, Ryabchenko and Lisman found that LST greatly reduces students’ tensionreduction via use of alcohol (2006). MacKillop, Ryabchenko and Lisman also found that
LST had a greater effect on female participants (2006). Botvin and Griffith examined
LST as a prevention program and found that LST’s effects last throughout the duration of
high school (2004). They concluded that the focus on risk and protective factors, as well
as on enhancing social and personal competence skills within this program make this a
very effective approach to prevention.
In regards to the philosophical considerations of this program, in regards to the
theoretical lens used by this project’s author, Life Skills training considers the whole
person and focuses on and enhances an individual’s positive traits, reflecting ideas
considered important in current theoretical frameworks.
Costs of implementation
There are costs to implement Life Skills Training. According to the information
on the website, through www.lifeskillstraining.com/lst_hs.php, the High School Program
36
basic curriculum set with Teacher’s Manual and 30 Student Guides is $265. Additional
Student Guides are $60 for every 10 purchased. Life Skills Training recommends that
the intended program implementers receive training through a Life Skills Training
workshop, either at available online, or can be delivered on-site for additional fees.
Online training for three sessions, or one day in-person trainings in White Plains, New
York listed on their website cost $235 plus training materials for three sessions according
to the registration information found through
www.lifeskillstraining.com/training_schedule.php.
Limitations and Considerations Regarding Life Skills Training
The program developer as a researcher is questionable. While the developer may
implement a program with high fidelity, they have a vested interest in positive results of
efficacy. The Journal of Primary Prevention noted under the article “Life Skills Training:
empirical findings and future directions” that Gilbert Botvin, one of the authors
reviewing LST in that article, was a consultant at a company providing LST training for
teachers, which certainly presents as possible conflict of interest (2004). Gilbert Botvin
was also one of the authors of the articles “Preventing alcohol and tobacco use through
Life Skills Training: theory, methods, and empirical findings” and “Effectiveness of a
universal drug abuse prevention approach for youth at high risk for substance use
initiation” (Botvin & Kantor, 2000; Griffin, Botvin, Nichols & Doyle2003) . Gorman’s
article “The ‘science’ of drug and alcohol prevention: the case of the randomized trial of
the Life Skills Training program” found in reanalyzing Botvin’s longitudinal study that
the research techniques used were not rigorous, and that claims made were not proven
37
(2002). The website www.lifeskillstraining.com says “Botvin Life Skills Training” at the
top of the page, and lists Gilbert Botvin as the program developer, thus rendering all of
his research as tainted to this author. Of the listed evaluation studies of research on the
Life Skills Training website, Botvin was an author in 19 of the 25 studies listed. While
Botvin was involved in these articles and creation of the program, multiple articles
without his involvement, including most of those mentioned in previous paragraphs, also
found efficacy of the LST program.
The website www.lifeskillstraining.com/lst_hs.php explains that the high school
program consists of ten sessions for use in grades nine or ten. The limited amount of
sessions involved would create a challenge for use in a school with a substance abuse
class meeting every day for six weeks, as desired by the project author for use in the
continuation high school setting. This program would require supplemental activities and
possible further break down of the curriculum in order to meet a continuation high
school’s needs.
Multisystemic Therapy
According to its website, www.mstservices.com, Multisystemic Therapy (MST) is
a family-based and community-based individual treatment that meets the participant in
their real-world settings. This program model’s efficacy and theoretical basis made this
program a desirable option to the author. It is considered effective on a variety of levels
and for numerous problems that often co-occur with substance abuse and commonly
affect continuation high school students.
38
This form of treatment is delivered on an individual basis and can incorporate
family involvement, providing guidance to caregivers as well (Chapman & Schoenwald,
2010). The practitioner meets the client at school, home, and other chosen settings, and
works with the client and people in their lives. It focuses on all of the participant’s
systems including family, community, peers, and school. It is possible to deliver this
individual treatment through a high school setting, but requires trained available
therapeutic practitioners. As such, this might not be useable for a wide scale treatment,
but seems promising for students required to participate in a substance abuse program at
school.
This program could be used in conjunction with a class, but alone Multisystemic
Therapy does not meet the project author’s desire for a classroom curriculum. It does
encompasses theoretical ideals of the author, such that it builds protective factors,
addresses problem solving, and believes in a positive theory of change (Henggeler,
Letourneau & Chapman, 2009). MST was developed for use with youth considered
delinquents, those at risk of being placed out of their home, those with problems in the
areas of family, peers, school, or community, areas that commonly affect students in
alternative education (Chapman & Schoenwald, 2010). The program’s efficacy on a
variety of levels and for multiple problems that often co-occur with substance abuse and
commonly effect continuation high school students made this program a desirable option
to the author. MST has been found to be effective with juveniles labeled as “delinquents,”
with juveniles who are sexual offenders, positively effecting antisocial and risk behaviors
(Henggeler, Letourneau & Chapman, 2009). The article “Juvenile drug court: enhancing
39
outcomes by integrating evidence-based treatments” reports that this model enhanced the
outcomes of juveniles involved in drug court (Henggeler, Halliday-Boykins,
Cunningham, Randall, Shapiro & Chapman, 2006). Worthy of note, however, is that
Henggeler, one of the authors of the article, is the original developer of the MST
program, per the program’s website at www.mstservices.com/index.php/mstservices/our-history.
The philosophical considerations of this program, in regards to the theoretical lens
used by this project’s author, that Multisystemic Therapy builds protective factors,
addresses problem solving, and believes in a positive theory of change, , reflecting ideas
considered important in current theoretical frameworks.
Costs of implementation
The website lists a five-day orientation, supervisor orientation workshop, an
advanced supervisor workshop, webinars and conferences as training and continuous
learning options. An agency should become an MST provider through MST Services.
Cost of a five-day training is listed at $850 per person. Other costs would inevitably
incurred for other training.
Limitations and Considerations Regarding Multisystemic Therapy
The developer of a program writing as a researcher is something to consider when
looking at programs. While the developer may implement a program with high fidelity,
they have a vested interest in finding positive results of efficacy. The article “An
independent effectiveness trial of Multisystemic Therapy with juvenile justice youth”
notes that much of the research on Multisystemic Therapy was performed by its
40
developers, Scott Henggeler and Charles Borduin (2006). It is also worth noting this
article found that MST produced significant results in multiple areas regarding recidivism
of juveniles involved in the justice system, but did not find a significant effect regarding
substance abuse, challenging the developers’ findings related to substance abuse effects.
According to the program’s website at www.mstservices.com/mstlicense.htm, full
implementation requires following the licensure that goes along with this program. This
licensure to fully implement MST has initial training, supervisor training, and ongoing
data collection. While the ideas of this approach encompass a lot of the risk and cooccurring issues that go along with substance abuse, implementation of this specific
program would be difficult, time consuming, and costly.
Multisystemic Therapy does not meet the project author’s desire for a classroom
curriculum, nor for affordability or implementation, but may meet a school’s need for
substance abuse treatment for individual students, given available practitioners.
Motivational Interviewing/Motivational Enhancement Therapy
Motivational Interviewing (MI) was developed by Miller and Rollnick
specifically to work with addiction issues. MI, including Motivational Enhancement
Therapy, a variation of MI grounded in the same theoretical framework, is a solutionfocused approach to substance abuse treatment (Atkinson & Amesu, 2007). Motivational
Interviewing encompasses much of the project author’s theoretical framework discussed
in Chapter 1.
MI involves collaboration with the participant, empowering the participant and
recognizing them as the expert in their own story and life, according to Cathy Atkinson’s
41
Power Point at www.ispaweb.org/Colloquia/China/Atkinson.ppt (2006). MI is
nonjudgemental, and involves self-determination by the participant (Lundahl, Kunz,
Brownell, Tollefson & Burke, 2010). Motivational Interviewing seeks to find out where
the clients are in relation to approaching any desire or readiness to quit (Atkinson &
Amesu, 2007). Motivational Interviewing then works on moving the participants through
the stages of change as the participants feel motivated: precontemplation, contemplation,
preparation, active change, maintenance, and relapse.
There have been numerous studies that found Motivational Interviewing is an
effective approach in dealing with substance abuse. Lundahl, Kunz, Brownell,
Tollefson, and Burke found that Motivational Interviewing is at least as effective as other
treatments, and has been found useful in twenty-five years of research (2010). Sobell and
Sobell found that an MI group therapy, evaluated positively in previous studies, proved
as effective as individual treatment in their research (2009). This study found significant
reductions in alcohol and drug use in post treatment follow up. Peterson, Baer, Wells,
Ginzler and Garrett used a brief MI group with homeless youth and found that use of
some substances was reduced (2006). Stephens, Roffman and Curtin found that a brief
treatment using MI was just as effective as a treatment of longer duration of a cognitivebehavioral treatment (2000).
Motivational Interviewing’s approach to exploring one’s readiness and motivation
to quit would be suited to participants that are not actively engaged in the process, such
as those mandated by a school’s administration to participate (Atkinson & Amesu, 2007).
This makes this approach a desirable match for the project author’s aims. This model also
42
seems promising for use with students on an individual level, if further research proves
undesirable effects of the grouping of higher risks people together, as suggested by Cho,
Hallfors, Sanchez and as well as by Hallfors, Cho, Sanchez, Khatapuch, Kim, and Bauer
(2005 & 2006).
SAMHSA recommends the use of Motivational Interviewing techniques with
adolescents in substance abuse treatment in their publication Treatment of Adolscents
with Substance Use Disorders (Winters, 1998). The NREPP website recommends MET
and MI as a counseling style for use with individuals 18 and over, and as appropriate for
use in school settings according to the summaries for these programs at
www.nrepp.samhsa.gov/ViewIntervention.aspx?id=107 and
www.nrepp.samhsa.gov/ViewIntervention.aspx?id=130 . Also worth noting, the
National Institute of Corrections recommends the use of Motivational Interviewing with
individuals involved in the criminal justice system in their publication Motivating
offenders to change: A guide for probation and parole (2007).
In regards to the philosophical considerations of this program, the theoretical lens
used by this project’s author matches well with the goal-oriented and resolution-focused
aim of this program, which recognizes the client as having the resources and abilities to
resolve their own problems and aid individuals in fulfillment.
Costs of implementation
Materials related to Motivational Interviewing’s implementation, some available
for download at no cost, are available through
www.motivationalinterview.org/quick_links/manuals.html, although there are many
43
training opportunities available as well, online or through the Addiction Technology
Transfer Center Network’s in-person trainings linked through the MI website via
www.motivationalinterview.org/quick_links/find_a_trainer.html. In the author’s
experiences as a Social Work student and Trainee in field experience, many practitioners
are familiar with the techniques of MI. Therefore, training and implementation costs
could be low.
Limitations and Considerations Regarding Motivational Interviewing
MI has largely been used in individual therapy. More research is needed on
Motivational Interviewing in group settings and with youth. There is no set curriculum
for the implementation of MI, but perhaps curriculum could be developed around the
ideas of Motivational Interviewing. Lundahl, Kunz, Brownell, Tollefson, and Burke
suggest that MI is effective with groups, but should also incorporate another component
as well, such as individual treatment (2010). They also claim that Motivational
Interviewing has an advantage in that MI has specific techniques that are easy for
practitioners to learn (2010). Motivational Interviewing’s proven efficacy in dealing with
substance abuse make this a promising choice as a basis in curriculum development.
Project SUCCESS
Project SUCCESS (Schools Using Coordinated Community Efforts to Strengthen
Students) is a comprehensive intervention program specifically targeted to high risk
students (Richards-Colocino, McKenzie & Newton, 1996; Clark, Rinwalt, Hanley,
Shamblen, Flewelling & Hano, 2010). This programs aims to effect substance use as it
reduces associated risk factors and increases the students’ resiliency and protective
44
factors. According to the webpage www.promoteprevent.org/publications/ebifactsheets/project-success Project SUCCESS works to build individual skills and aims to
change a community’s attitudes, perceptions and policies.
Clark, Ringwalt, Hanley, Shamblen, Flewelling, and Hano researched Project
SUCCESS and found initial reduction of most substances, but results did not remain
endure through follow up year later. These researchers stated that while results were not
proven effective long term, the students’ exposure was low and in a setting with more
regular attendance results might be different (2010). Other evaluations of Projects
SUCCESS cited by Clark, Ringwalt, Hanley, Shamblen, Flewelling, and Hano found
substantial desirable impact. They cite the unpublished work of Vaughan and Johnson,
regarding two studies of Project SUCCESS which found that substance use among
participants decreased to a significant degree or prevented use of some substances.
Shamblen and Ringwalt analyzed archival data on Project SUCCESS (2008).
They found that Project SUCCESS had positive outcomes related to grades and school
attendance for the two years after the program exposure.
In regards to the philosophical considerations of this program, the theoretical lens
used by this project’s author matches well with this program’s theoretical basis in that it
looks at the whole person, including the individual in relation to all the various aspects
and influences in their life.
Costs of implementation
According to the webpage www.promoteprevent.org/publications/ebifactsheets/project-success Project SUCCESS contains five parts. There are eight
45
discussion groups, individual and group counseling, school-wide activities, parent
programs, and referrals to more intensive treatment in the community when necessary.
The minimal cost to implement this program would be the Project SUCCESS manual,
which can be purchased through the developer’s website for $150. A three-day training
is recommended to implement this program effectively. There are also manuals, articles,
handouts and a data collection log, available to those who participate in trainings, most
included in the fee.
Limitations and Considerations Regarding Project SUCCESS
This was the only program developed specifically for the indicated population of
alternative school students. While there is limited research on this program’s efficacy in
regards to substance abuse, this program is promising in its theories and approaches.
This comprehensive program addresses the many factors influencing students, and was
created for use with alternative school students, factors which make this program a viable
choice for a curriculum to implement, or a great model to use in creating and organizing a
school site-specific substance abuse program.
46
Chapter 5
SUMMARY, CONCLUSIONS AND IMPLICATIONS
The author believed there was a need for an effective cost-conscious alternative high
school substance abuse curriculum that could be easily implemented. This study was
designed to examine the NREPP evidence-based recommended programs that might be
applicable in an alternative education setting, and look at strengths and shortcomings of
these curriculums. The author was interested in the curriculums currently available, and
wondered about their theoretical frameworks, efficacy, efficiency, measures of success,
costs, best practices and the implementation process. This project set to review literature
regarding substance abuse, including specific requirements of substance abuse curriculum
used in California public schools. This project considered which curriculums of the
available curriculum for settings such as the writer’s previous experience would most
likely be employed, and explored the implementation and results found regarding these
specific programs.
While this project did not answer each of the author’s areas of desired inquiry for
each program examined, results yielded curriculums that are viable options for use in an
alternative high school setting. These programs could also be models for a school site to
develop their own program, as a way to control the costs associated with using some of
the programs already in existence.
If these findings lead to the creation of a new curriculum based on the programs
explored, certainly the newly created program will need to verify its efficacy through
scientific research.
47
What Can be Learned From the Limited Research of the Curriculums Not
Considered for Implementation?
In Reconnecting Youth, the grouping together of high-risk youth was found to
have negative effects on the students, an interesting finding in regards to alternative
education, as the focus in this curriculum evaluation project, as alternative education is a
grouping of higher risk students together (Hallfors, Cho, Sanchez, Khatapuch, Kim &
Bauer, 2006; Cho, Hallfors & Sanchez, 2005). This suggests that further grouping of
students into a more targeted group may have negative effects, suggesting that the idea of
a substance abuse class might not be a beneficial approach.
This research might be read as an argument against all grouping of high risk
students together. The student body at a continuation high is representative of higher risk
students in its population, making an indicated class within this population
The use of multilevel community-based interventions programs like
CASASTART and Project Northland, are promising, but lack research with high school
students (Murray & Belenko, 2005; Komro, Perry, Williams, Stigler, Farbakhsh &
Veblen-Mortenson, 2001).
Alcohol Edu does not address students already drinking, lacks available research
with high school students, and is not itself a class curriculum, but an individual approach
utilizing technology could be useful and easily implemented (Lovecchio, Wyatt &
DeJong, 2010).
The use of a culturally relevant approach appears to be promising in the
implementation of a curriculum, as it was in the Skills Training with Hispanic youth, and
48
the program Hip-Hop to Prevent Substance Use and HIV (Botvin, Dusenbury, Baker,
Ortiz & Kerner, 1989; Turner-Musa, Rhodes, Harper & Quinton, 2008).
Protecting You/Protecting Me’s use of students as teachers seems promising
regarding not only substance use, but in impacting high school students in other prosocial
aspects of their development as well (Padget, Bell, Shamblen & Ringwalt, 2005).
The coupling of athletics and substance use intervention in Project SPORT is
promising in its limited scope (Werch, Carlson, Pappas, Edgemon & DiClemente, 2000;
Werch, Moore, DiClemente, Owen, Jobli & Bledsoe, 2003; Werch, Moore, DiClemente,
Bledsoe & Jobli, 2005). This might be worth considering as an alternative to a class
specifically focused on substance abuse, to have substance abuse interventions built into
curriculum of exercise and health in an exercise-based course at the high school level.
Considerations Regarding the Evaluated Programs for Possible Implementation
The researcher who is also the program developer calls the results of such
research into question. While the developer may implement the program with high
fidelity, they have a vested interest in positive results of efficacy. Replication by
impartial researchers through scientifically valid processes are necessary to verify the
findings of some of the available research.
Many studies were conducted with small sample size. Replication and validity are
uncertain, as these findings may not generalize to the general population of students.
Desired outcomes and measures of success may vary greatly. For example, Sobell
and Sobell considered reductions in use successful (2009). However, the goal at the
continuation high school of this author’s previous position would be to eliminate any
49
substance use, as seems to be the common aim of educational entities regarding substance
abuse.
The Life Skills Training program consists of ten sessions for use in grades
nine or ten. The limited amount of sessions involved would create a challenge for use in
a school with a substance abuse class meeting every day for six weeks, as desired by the
project author for use in the continuation high school setting. This program would require
supplemental activities and possible further break down of the curriculum in order to
meet a continuation high school’s needs.
Multisystemic Therapy does not meet the project author’s desire for a
classroom curriculum, but may meet a school’s need for substance abuse treatment for
individual students, given available practitioners. If the findings that grouping students
together in such a fashion, as is intended in the school setting familiar to the author, this
may prove a viable alternative.
Motivational Interviewing’s approach to finding any desire or readiness to quit
would be suited to participants that are not actively engaged in the process, such as those
mandated by a school’s administration to participate (Atkinson & Amesu, 2007). This
makes this approach a desirable match for the project author’s aims. However, there is no
actual curriculum for the implementation of MI. Perhaps an actual program curriculum
could be developed around the ideas of Motivational Interviewing. At this time MI does
not meet the California State Board of Education’s Health Framework for California
Public Schools Kindergarten Through Grade Twelve requirement that a curriculum
should have a complete curricular package (2003). As is, this model also seems
50
promising for use with students on an individual level, especially if it is deemed more
desirable to avoid the grouping of high risk students together.
Project SUCCESS was the only program developed specifically for the indicated
population of alternative school students. While there is limited research on this
program’s efficacy in regards to substance abuse, this program is promising in its theories
and approaches. This comprehensive program addresses the many factors influencing
students, and was created for use with alternative school students, factors which make
this program a viable choice for a curriculum to implement, or a great model to use in
creating and organizing a school site-specific substance abuse program.
Recommendations in Selecting or Creating Curriculum Based on These Findings
The impact on students’ self-efficacy and self-esteem through the interactive
approach of Life Skills Training, the individualized approach of Multisystemic Therapy,
Motivational Interviewing’s effective approach to “reluctant” participants, the
comprehensive approach of Project SUCCESS, are all components that make these
curriculums viable choices for implementation, or for reference in the creation or a new
curriculum. A new curriculum might be created with elements of these curriculums in
mind.
51
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