Prevention Research Rob O’Neill U of U Special Ed class November 19, 2009.

Prevention ResearchPrevention Research

Rob O’NeillRob O’NeillU of U Special Ed classU of U Special Ed class

November 19, 2009November 19, 2009


Rob O’NeillRob O’NeillU of U Special Ed classU of U Special Ed class

November 19, 2009November 19, 2009

Definition of Prevention

• How would YOU

define

PREVENTION ?

Definition of Prevention

A proactive process that empowers individuals and systems to foster a climate in which:

• Alcohol use is acceptable only for adults when risk of adverse consequences are minimal

• Prescriptions, over-the-counter drugs, and other abusable substances are used only for their intended purposes and as intended

• Illegal drugs and tobacco are not used at all

(CSAP’s Prevention Primer, 1994; SW CAPT online glossary)


Why study prevention research?

• “Evidence-based” prevention is the standard of accountability in the field

• Prevention theory assists in identifying what contributes to substance abuse and how it can be prevented

• Results depend on the quality of the research that guides prevention

What is “Evidence-based” Prevention?

• Based upon research meeting commonly agreed-upon criteria of rigor

• Guided by credible and substantiated research evaluation

• Principles, strategies and programs that are theory-driven, well implemented, and shown to have an effect on specific behaviors, or on specific risk factors that have been linked to them

(SAMHSA’s Prevention Platform online glossary and CSAP’s Southwest CAPT Community Mobilization for Prevention online course glossary)

Why All the Concern Over Evidence-based Prevention?

• To use the most effective programs and strategies

• To improve existing programs

• To use limited resources wisely

• To ensure public accountability

• To meet requirements of federal and state agencies and private funders

What Should a Good Theory What Should a Good Theory Do?Do?

• Identify the factors that predict substance Identify the factors that predict substance abuseabuse

• Explain the mechanisms through which Explain the mechanisms through which they operatethey operate

• Identify the internal and external Identify the internal and external variables that influence these variables that influence these mechanisms, including cultural factorsmechanisms, including cultural factors

• Predict points to interrupt the course Predict points to interrupt the course leading to substance abuseleading to substance abuse

• Specify the interventions to prevent onset Specify the interventions to prevent onset of substance abuseof substance abuse

Activity

• Similar to public health model of disease Similar to public health model of disease prevention: focus on decreasing prevention: focus on decreasing riskrisk and and increasing protectionincreasing protection

• Risk factors predict substance abuse and Risk factors predict substance abuse and protective factors can buffer risk factorsprotective factors can buffer risk factors

• To prevent substance abuse, reduce risk To prevent substance abuse, reduce risk factors and increase protective factors factors and increase protective factors throughout an individual’s lifethroughout an individual’s life

Risk & Protective Factors Risk & Protective Factors TheoryTheory

Risk and protective factors:Risk and protective factors:

• Can be influenced by individual, Can be influenced by individual, family, school, and environmental family, school, and environmental change strategieschange strategies

• Have a cumulative effectHave a cumulative effect

• Occur in communities, families, Occur in communities, families, schools, and individuals and are schools, and individuals and are subject to changesubject to change


• Different adolescent health and behavior Different adolescent health and behavior problems share common risk factorsproblems share common risk factors– Substance AbuseSubstance Abuse– DelinquencyDelinquency– Teen PregnancyTeen Pregnancy– School Drop-outSchool Drop-out– ViolenceViolence– Depression & AnxietyDepression & Anxiety


• Multiple studiesMultiple studies• LongitudinalLongitudinal• PredictivePredictive

Criteria for Inclusion Criteria for Inclusion as a Risk Factoras a Risk Factor

Community Risk FactorsCommunity Risk Factors

• Availability of alcohol/other drugsAvailability of alcohol/other drugs

• Community laws and norms Community laws and norms favorable toward drug usefavorable toward drug use

• Transitions and mobilityTransitions and mobility

• Low neighborhood attachment and Low neighborhood attachment and community disorganizationcommunity disorganization

• Extreme economic deprivationExtreme economic deprivation

Risk Factors

AdolescentProblem Behaviors

Do-main

Substance

Abuse

Depression

& Anxiety

Delin-quency

Teen Preg

School Dropout

Violence

COMMUNITY

Availability of alcohol/other drugs

Community laws and norms favorable to drug use

Transitions and mobility

Low neighborhood attachment and community disorganization

Extreme economic deprivation

Family Risk FactorsFamily Risk Factors

• Family history of substance abuseFamily history of substance abuse

• Family management problemsFamily management problems

• Family conflictFamily conflict

• Parental attitudes and Parental attitudes and involvement in drug useinvolvement in drug use

Risk Factors


Do-main

Substance

Abuse

Depression & Anxiety

Delin-quency

Teen Preg

School Dropout

Violence

FAMILY

Family history of the problem behavior

Family management problems

Family conflict

Favorable parental attitudes and involvement in problem behaviors

School Risk FactorsSchool Risk Factors

• Academic failure beginning in Academic failure beginning in elementary schoolelementary school

• Lack of commitment to schoolLack of commitment to school

Risk Factors


Do-main

Substance

Abuse


Delin-quency

Teen Preg

School Dropout

Violence

SCHOOL

Academic failure beginning in late elementary school

Lack of commitment to school

Individual/Peer Individual/Peer Risk FactorsRisk Factors

• Early and persistent antisocial behavior *Early and persistent antisocial behavior *

• RebelliousnessRebelliousness

• Friends who use drugsFriends who use drugs

• Favorable attitudes toward drugsFavorable attitudes toward drugs

• Early initiation of drug useEarly initiation of drug use

• Gang involvementGang involvement

• Constitutional factors *Constitutional factors *

* Child Development Journal ©2006

CHILDREN WHO• had less control over their behavior and

impulses between 3 and 5 years of age • gained behavioral control more slowly

WERE MORE LIKELY TO• drink alcohol at age 14• develop an alcohol problem• try illicit drugs

Source: Dr. Maria M. Wong, Idaho State UniversitySociety for Research in Child Development

* MRDD Research Reviews 2006; 12:41-47

• TITLE: A review of substance use research among those with mental retardation

• AUTHOR: Neil B. McGillicuddy• ABSTRACT: This article reviews research

conducted on the cigarette, alcohol, and illicit drug use of adolescents and adults with mental retardation (MR). Overall, results of these studies suggest that, although substance use is slightly lower among those with MR than among nondisabled comparison groups, it is nonetheless a problem for many individuals. Further, the examination of education, prevention, and treatment programs for this population has been overlooked. The article concludes with a discussion of several topics that need to be addressed in future studies, including best practices.

© 2006 Wiley-Liss, Inc.

* ERIC Identifier: ED4694411 2002-08-00

Title: Substance Abuse Prevention and Intervention for Students with Disabilities: A Call to Educators

Author: McCombs, Kathryn - Moore, Dennis Source: ERIC Clearinghouse on Disabilities and Gifted Education Arlington

VA

• Youth with disabilities experience a substantially higher substance abuse risk than their nondisabled peers.

• In addition to the same risk factors as their counterparts in regular education, they also face many disability-specific factors, such as prescribed medications, chronic medical problems, social isolation, co-existing behavioral problems, and disenfranchisement.

• While educating youth with disabilities in inclusive settings exposes them to positive learning opportunities in the classroom, they also have more exposure to peer pressure for substance use, and at earlier ages.

• On the other hand, children in contained special education classrooms often have less socialization practice or skills, and may use substances in order to feel accepted by their peers.

• Compared with their counterparts in regular education, a significantly greater proportion of students who have been in special education classes live in single-parent and nontraditional households, have a family member with an alcohol or other drug problem, have witnessed or experienced physical abuse, and report a history of sexual abuse and poor emotional health (Borowsky & Resnick, 1998).


Research indicates that people with MR/DD, 11% of the special education population nationwide in 2000-2001, use alcohol and other drugs at rates less than or similar to the general population (Westermeyer, Kemp & Nugent, 1996).

Because judgment and other social skills tend to require more concentration for MR/DD students, the same amount of alcohol can impact cognitive and motor skills more severely.

Other significant risks faced by youth with MR/DD include communication barriers, increased family stress, enabling behaviors of family and friends, use of therapeutic medications which may themselves be addictive, and secondary complications from combining therapeutic medications with illicit drugs or alcohol. Nonetheless, controlled research dealing with the origin and prevention of drug abuse among people with MR is essentially nonexistent, but badly needed (Christian, & Poling, 1997).


Special education students with emotional disturbance (ED), who in 2001 comprised 8% of the special education population nationwide, frequently have one or more additional disabilities.

Speculated to be the highest risk group of all students in school, these students are put at an inordinate risk for violence and substance abuse by stressful family situations and unsuccessful school experiences.

The increased risks appear to be related to the inability to develop healthy peer and family relationships, social isolation, oppositional-defiant behavior, use of therapeutic psychotropic medications, and social and communication barriers.


About half the students diagnosed with attention-deficit/hyperactivity disorder (ADHD) receive special education services as a result of other learning disabilities (Substance Abuse and Mental Health Services Administration, 1998).

People with this condition often experience a variety of coexisting problems including anxiety and depression, low self-esteem, obsessive-compulsive behaviors and chemical addictions (Hallowell & Ratey, 1995).

With or without hyperactivity, attention deficit disorder does not disappear after the onset of puberty, and it can lead to social and scholastic failure. It often results in increased risk of substance abuse, as well as trauma, conduct and affective disorders during adolescence and marital disharmony, family dysfunction, divorce and incarceration in adulthood.

Additionally, prescribed medications may be a risk factor for some forms of subsequent alcohol and other drug abuse.


Low incidence disabilities: <5% of students in special ed.

Increased risk for alcohol and other drug abuse problems among people who are blind or visually impaired has been associated with isolation, excess free time, and underemployment (Nelipovich & Buss, 1991). Youth with visual impairments may face fewer consequences from alcohol and other drug abuse due to the enabling of others, social isolation, and constraints imposed by the disability.

People with severe hearing loss or deafness do not have ready access to appropriate alcohol and other drug information. When problems do exist, treatment professionals lack the training required to meet their needs (Guthman, 1995). Alcohol and other drug abuse prevention materials do not take into account the cultural, language, or communication differences faced by people who are hearing impaired. There is also concern that people who are deaf more vigorously attempt to avoid social stigma associated with an alcohol or other drug abuse label, thereby making detection of problem use more difficult.


Disabilities with traumatic origin are strongly associated with substance abuse. Specifically, as many as 50% of spinal cord injuries (SCI) and traumatic brain injuries (TBI) occur as a direct result of alcohol or drug abuse (Corrigan, Rust, & Lamb-Hart, 1995). Many people with SCI or TBI continue to be at risk for substance abuse problems post-injury. Some people with mobility limitations are required to take several medications for health management, which greatly increases the risk for complications arising from alcohol or other drug misuse. For example, many brain-injured individuals take medications to prevent seizures. There are serious contraindications for use, even in small quantities, of alcohol or non-prescribed drugs for people using anti-seizure medication.

Risk Factors


Do-main

Substance Abuse


Delin-quency

Teen Preg

School Dropout

Violence

INDIVIDUAL

Early and persistent antisocial behavior

Rebelliousness

Friends who engage in the problem behavior

Favorable attitudes toward the problem behavior

Gang involvement

Constitutional factors

Protective FactorsProtective Factors(community, family, school, peer)(community, family, school, peer)

• Individual characteristics

•Resilient temperament

•Positive social orientation

• Bonding

•Opportunities

•Skills

•Recognition

• Healthy beliefs and clear standards

The Social Development Strategy

Healthy Beliefs&

Clear Standards

Bonding•Attachment

• Commitment

Healthy Behaviors

Opportunities Skills Recognition

IndividualCharacteristics

Resiliency Approach *Resiliency Approach *

• Focuses on how children “bounce back” in the face of adversity

• Is based largely on the work of Emmy Werner in Hawaii

• Includes several factors which foster resilience in kids

• Is a “promising” approach

* Child Development Journal ©2006

CHILDREN WHO• Were “resilient” in early childhood, e.g.,

– Were more flexible– More readily adapted to a changing

environment

WERE LESS LIKELY TO• Start drinking alcohol in early teenage years• Display signs of sadness, anxiety,

aggressiveness, or delinquent behavior

Source: Dr. Maria M. Wong, Idaho State UniversitySociety for Research in Child Development

Developmental AssetsDevelopmental AssetsFrameworkFramework

• Emphasizes strengths in people

• Is based on the work of Peter Benson of the Search Institute

• Focuses on youth as resources, not problems

• Focuses on increasing the number of assets present in youths’ lives

• Is a “promising” framework

Blended Model

• Social Development Strategy

• Developmental Assets

Community

Family School

Individual/Peer

Other Adult RelationshipsOther Adult RelationshipsService to OthersService to OthersCreative ActivitiesCreative ActivitiesYouth ProgramsYouth Programs

Youth as ResourcesYouth as ResourcesTime at HomeTime at Home

Parental InvolvementParental InvolvementReading for PleasureReading for Pleasure

Homework Homework

Personal PowerPersonal PowerCultural CompetenceCultural CompetenceFamily BoundariesFamily Boundaries

Interpersonal CompetenceInterpersonal CompetencePeaceful Conflict ResolutionPeaceful Conflict ResolutionPlanning & Decision MakingPlanning & Decision Making

Resistance SkillsResistance Skills

Community Values YouthCommunity Values YouthYouth Given Useful RolesYouth Given Useful Roles

Caring School ClimateCaring School ClimateHigh ExpectationsHigh Expectations

Neighborhood BoundariesNeighborhood BoundariesEquality & Social JusticeEquality & Social Justice

School BoundariesSchool BoundariesIntegrityIntegrity

Honesty Honesty ResponsibilityResponsibility

Sense of PurposeSense of PurposePositive View of Positive View of Personal FuturePersonal Future

Delays GratificationDelays GratificationOvercomes AdversityOvercomes AdversityExhibits LeadershipExhibits Leadership

Resists DangerResists Danger

Succeeds in SchoolSucceeds in SchoolHelps OthersHelps Others

Values DiversityValues DiversityMaintains Good HealthMaintains Good Health

Caring NeighborhoodCaring NeighborhoodReligious CommunityReligious Community

Adult Role ModelsAdult Role ModelsSafetySafety Family SupportFamily Support

Positive Family Positive Family CommunicationCommunication

Bonding to SchoolBonding to SchoolSchool EngagementSchool Engagement

Achievement MotivationAchievement Motivation

Positive Peer InfluencePositive Peer Influence

Personal Control Self-Personal Control Self-EsteemEsteem

RestraintRestraint

SkillsOpportunities

Healthy Behaviors

Healthy Beliefs &Clear Standards

Individual Characteristics

Recognition

Bonding

SHARP Survey

• Student Health and Risk Prevention comprises:– Youth Tobacco Survey– Youth Risk Behavior Survey– Prevention Needs Assessment

• Administered every other year• Active parental permission required• 6th, 8th, 10th, and 12th graders statewide• Results at http://

www.dsamh.utah.gov/sharp.htm

http://www.dsamh.utah.gov/sharp.htm


2009 Summary• 40,832 students in 37 school districts

– Grade: 6 13638 33.4%

8 10926 26.8%10 9275 22.7%12 6992 17.1%

– Gender: M 19418 48.3%F 20809 51.7%

– Ethnicity: Afr Amer 544 1.4%

Amer Ind 778 1.9%Asian 695 1.7%Hispanic 4848 12.1%

^Pac Island 600 1.5%

^White 30339 75.7%Multi-racial 2288 5.7%

^

2009 Summary

• Survey is collaborative effort among:– Division of Substance Abuse & Mental

Health– Office of Education– Department of Health

• Contains 4 types of data:– Substance use– Antisocial behavior – Risk Factors– Protective Factors

2009 Summary•Substance use

– Ever used– 30-day use– Heavy Use, Need for Treatment– Antisocial behaviors (Grade 12)

– Drunk or “high” at school ^– Suspended from school ^ – Sold illegal drugs ^– Stolen a vehicle ^– Been arrested ^– Attacked to harm ^– Carried a handgun ^– Took a handgun to school =


– Sources & Places of Alcohol Use (new!)• bought it myself from a store• got it at a party (#1 Grade 12)• gave someone else money to buy it for me• got it from someone I know age 21 or older (#2)• got it from someone I know under age 21 (#3)• got it from a family member or relative

other than my parents• got it from home with my parents’ permission• got it from home without my parents’ permission• got it in another way


– Sources & Places of Alcohol Use (new!)• My or someone else’s home without any parent

permission (#1 Grade 12)• Home with my parents’ permission• Someone else’s home with their parents’

permission (#3)• Open area like park, beach, back road (#2)• Public events like sports, concert, festival• Restaurant, bar, nightclub• In a car• Some other place

2007 Summary

•Gambling (11)– Gambled in the past year– Gambled at a casino– Played the Lottery– Bet on sports– Bet on cards– Bet on horses– Played Bingo for money– Gambled on the internet– Bet on dice– Bet on games of skill– Bet on video poker

• Baseline Data

2009 Summary

80. How often have you bet money, possessions, or anything of value on the results of a card game such as poker, sporting event, games of skill such as pool or bowling, bingo, dice, or other games?

• Never• Not in the past year• A few times in the past year• Once a month• Once a week or more• Almost everyday

2009 Summary

• Risk Factors• Protective Factors

Highs/lows will vary from area to area.

Check website for data specific to your school district or planning district.

Generally speaking. . .• Utah use rates are about ½ of

national rates

• Most frequently used substances1. alcohol2. tobacco3. marijuana

• Utah rates for most substances are down from 2005 and/or 2007– “Needs treatment” responses also down– Exceptions: slight rise in cigarettes, chewing

tobacco, and marijuana

• New! rates of methamphetamine, prescription drug abuse, steroids abuse, and gambling. ???


Prevention Substance abuse prevention efforts have improved greatly during

the past decade. Schools are attempting more comprehensive, research-based strategies; community and family involvement are being identified as required ingredients for successful programming. Unfortunately, youth with disabilities have been largely neglected in this process.

Drug-free school coordinators and substance abuse counselors rarely have the necessary training to adapt traditional prevention messages for special education students.

Special education teachers seldom have the necessary training in substance abuse to conduct prevention activities or to identify risk factors or signs of abuse.

Consequently, very few, if any, school or social service personnel are prepared to intervene or educate disabled students relative to substance abuse.


Prevention The need to advocate for appropriate prevention and treatment

options for students with disabilities is clear. Our children in special education are no longer "sheltered" from the rest of the world in contained classes and separate schools.

The need for specific prevention education training and materials for teachers and other adults is equally clear. By adapting and modifying activities, all those who care about and work with young people with disabilities can address the particular learning style of the child to make prevention messages more relevant and interventions more effective.

More than half of special education teachers report that they conduct prevention activities once a year or less; only 15% conduct such activities at least once a week (Morgan, Genaux, & Likins, 1994).

YOUR CHALLENGE?

Local Substance

Abuse and

Mental Health Service Areas

Local Prevention SpecialistsAREA NAME EMAIL

Bear River Cathy Curtis [email protected]

Central Jolene Blackburn [email protected]

Davis Debi Todd [email protected]

Four Corners Rick Donham [email protected]

Heber Trudy Brereton [email protected]

Northeastern Robin Taylor [email protected]

San Juan Leslie Wojcik [email protected]

Salt Lake Jeff Smart [email protected]

Southwest Allen Sain [email protected]

Summit Julie Blanton [email protected]

Tooele Julie Spindler [email protected]

Utah County Pat Bird [email protected]

Weber Paula Price [email protected]

mailto:[email protected]




For more information


Noreen [email protected]




QUESTIONS and QUESTIONS and DISCUSSIONDISCUSSION

QUESTIONS and QUESTIONS and DISCUSSIONDISCUSSION

Prevention Research Rob O’Neill U of U Special Ed class November 19, 2009.

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Transcript of Prevention Research Rob O’Neill U of U Special Ed class November 19, 2009.