Definition of Prevention
Institute of Medicine Continuum Model
Six Strategies
Research review - mini lecture and transparencies
V:2-1 CSAP Definition of Prevention
V:2-2 Institute of Medicine Continuum
V:2-3 Six Strategies in Prevention
V:2-4 Examples of Parenting Programs in each Strategy
V:2-5 What is the Extent of Influence by Family?
V:2-6 Influence on Youth: Self-reported
V:2-7 Heroes of Youth
V:2-8 Peer vs. Parental Influence and Substance Use
V:2-9 How Much Influence do Parents Have Today
V:2-10 Parental Influence on children's Drug Use
V:2-11 How Does the Family Influence the Youth?
V:2-12 Use and Attitude Towards Use by Parent
V:2-13 Communications
V:2-14 Monitoring of Time and Activity
V:2-15 Bonding
V:2-16 Family Culture Questions
Other materials needed:
easels, newsprint, magic markers, masking tape, overhead projector and
screen
Drop and discuss V:2-1 CSAP Definition of Prevention
Explain that, in the interests of time, we will briefly mention a working definition of prevention that CSAP has been using for some time.
Prevention is a proactive process which empowers individuals and systems to meet the challengers of life events and transitions by creating and reinforcing conditions that promote healthy behaviors and life styles.
Now we are going to explore the Institute of Medicine Continuum model.
(Note: Make reference to the links between the CSAP definition and the IOM continuum. Also, mention how the six strategies will give further development to these two models.)
Drop and discuss V:2-2 Institute of Medicine Continuum
Explain that CSAP is now starting to use a model of prevention and treatment that divides prevention activities into three areas of programming, depending on the target audience: universal, selective, and indicated.
Universal: these prevention activities target the general public or a whole target group that is not identified by individual risk factors. For example, a media campaign, health fair, laws on seat belts and drunk driving.
Selective: these prevention activities target a group of the population whose risk of developing substance abuse problems are higher than that of the general population. For example, latchkey children, children of substance abuse users and abusers, children experiencing failure at school.
Indicated: these prevention activities target individuals who are identified as having minimal but detected signs or symptoms of substance abuse, but do not meet diagnostic levels for treatment at this time. For example, schools for drunk drivers, Student Assistance Programs (SAP) and Employee Assistance Programs (EAP). Indicated programs are usually considered to be early intervention programs.
We can look at parent education programs in this same way. There are some that are ideally suited for all general audiences, e.g., Preparing for the Drug Free Years, Effective Black Parenting. Some are designed for selective audiences and indicated audiences, such as Strengthening Families.
Just as we have a definition of prevention in terms of our target audiences, we can also look at prevention in terms of the activities that we use in working with these audiences. CSAP uses a comprehensive model of six strategies to help us organize the activities and processes of prevention for these target groups.
Six Strategies:
One way to look at prevention programming is in terms of the strategies we use or the processes we use in doing the work.
Drop and discuss V:2-3 Six Strategies in Prevention
The briefly explain each.
Information: provide appropriate and culturally sensitive information that gives basic, accurate, and current health risk facts on the use of substance abuse. The educational material must be appropriate for the target audience, geared towards specific needs, and is most effective when used in conjunction with other strategies. Examples are media programs, brochures, newspaper and magazine articles, newsletters, and billboards.
(Note: Explain that none of these strategies is mutually exclusive; e.g., skills building uses information; community mobilization usually uses all strategies.)
Skills Building: develop life skills that are critical to handle healthy living for oneself, one's family, and one's work. These skills include parenting skills, media literacy, communication, stress management, problem solving, conflict resolution and refusal skills.
(Note: You may want to draw a circle with the 6 strategies in 6 segments.)
Alternatives: provide meaningful, skill building activities. These may include parent to parent groups, adopt a family program, support groups, mentoring programs, recreational and other family outing programs.
Social Policy: programs that seek to influence and change informal and formal policies at the family, local, state, and national levelsto improve family life. The changes may serve to enhance or protect family life, such as parent leave policies for the work place. They may seek to prevent harm to the family, such as place of purchase and place of advertising laws, and regulations on sales to minors.
Community Mobilization: programs that generally include all of the above strategies. They seek to enhance community group efforts in a concentrated approach to examine, plan, and carry out a systematic effort to lower substance use and abuse. A comprehensive community plan uses multiple systems and multiple strategies to strengthen the capacity to foster healthy life and growth for all individuals and families within the community.
Early Intervention: programs that provide assessment and
evaluation, either into treatment programs or support programs such as
student assistance programs and other groups such as groups for children
of divorcing parents.
Drop and discuss V:2-4 Examples of Parenting Programs in each strategy
Discuss each strategy and ask for examples of each from the participants. Give the example of a parenting group that -
There have been many studies that have looked at all of the influences on youth. We have chosen just a few for you to review with us today.
Note: all of the research studies reviewed here are referenced in the Resource Guide, in an article reviewing this research. The article also contains many other studies. The Resource Guide contains a bibliography and a section on Internet Web pages that gives the participant access to hundreds of research articles.
Note: You do not have to use all of these studies. Use time, interest of the audience, and composition of your audience as your guide.
Drop and discuss V:2-5 What is the Extent of Influence by Family?
First, we will look at studies that show the extent of the influence of family as self-reported by young people. Then we will look at the ways in which that family influences the youth.
Drop and discuss V:2-6 Who is a Big Influence on my Life
Review this data briefly.
We are going to very briefly review 3 or 4 studies of many studies that are available, all with very similar results that measure the influence of family upon the youth.
This study was done by Newsweek for a special feature issue on Youth in America Today. They did a sample study of youth 12 - 17 across America. Of the many questions they asked, they asked youth "Who has a very important influence on you?" The youth could give as many responses as they wished. Here are the results.
Drop and discuss V:2-7 Heroes of Youth
Review this data briefly.
Here is a study done by USA Today which asked youth 9 - 13 across America
"Do you have a hero?"
60% said they did.
Then the questioner asked, "Who is the hero?" Here are the results.
Drop and discuss V:2-8 Peer vs. Parental Influence and Substance Use
(Note: The influence of the parent can be either positive or negative.)
Review this data briefly.
This study was done by Coombs et al in California with Hispanic youth.
It asks two groups of youth, those who have used alcohol and/or illegal
drugs, and those who have not used the influence of parents as compared
with friends. Here are the results.
Drop and discuss V:2-9 How Much Influence
Here are the results of the CASA study from Columbia University. These students were a large sample of youth 12 -17 from across the United States.
The youth were asked, "How much influence do parents have today over whether teenagers your age will smoke, drink, or try illegal drugs?"
Here are the results:
Drop and discuss V:2-10 Parental Influence on Children's Drug Use.
These findings are from the latest annual PRIDE survey. It surveys
youth, grades 6 - 12, across the United States.
Drop and discuss V:2-11 How Does the Family Influence the Youth?
Note: Stress very clearly that there are many factors besides family factors.
Note: We will talk about the resiliency on young people and what builds resiliency. Factors that build resiliency we will call "resiliency" factor: some people call them "protective factors."
Review that the research on risk and resilience shows that there are many factors that influence whether a youth will use drugs. The risk factors and resiliency factors in the research are often divided into individual, family, peer, school, and community domains. In this training we are going to look only at the family risk and resiliency factors. However, for the purposes of this workshop, we will be looking at only family risk and resiliency factors. The others are important, but we will not study them in this workshop. The ones we will study can be roughly divided into these categories:
One of the earliest risk factor discovered through research is the family history of drug abuse (Hawkins, 1983).
If a parent or caregiver uses substance abuse, the youth is more likely to use at an earlier age.
And if the parent allows the youth to drink at home, the youth is more
likely to use more, and get into trouble with abuse.
Drop and discuss V:2-13 Communications
Note: These studies are all referenced in the Resource
Guide, in the review of literature.
The research bibliography on the importance of good communication is
very large.
Generally, the studies show that parents who are not punitive and harsh,
and who are not laissez-faire, but use, warm, firm and clear communications
patterns have children who are less likely to use substance abuse.
Drop and discuss V:2-14 Monitoring of Time and Activity
The issue of lack of monitoring has received considerable attention in recent years. One study found that latchkey youth who were home alone two or more days per week were four times more likely to have gotten drunk in the past month than those youth who had parental supervision five or more times a week (Mulhall, Stone, and Stone, 1996). Another found that children who had the least monitoring initiated drug use at earlier ages. The contrast in risk of initiating alcohol, tobacco, or other drug use across levels of parent monitoring was greatest when children were under 11 years old. At older ages there was not difference in risk for these drugs. However, for marijuana, cocaine, and inhalant drugs, there was a sustained risk of starting to use these drugs for youth who received low levels of monitoring in middle childhood (Chilcoat and Anthony, 1996).
Another study confirms that parental support and monitoring are important predictors of adolescent drinking, delinquency, and related problem behaviors, even after taking into account critical demographic and family factors, including socioeconomic indicators, age, gender, race of the youth, family structure, and family history of abuse (Barnes and Farrell, 1992). The authors suggest that their findings demonstrate a less frequent occurrence of overt peer pressure than commonly believed. Youth did not report pressure from friends to engage in negative behaviors. However, wanting to be accepted, wanting to belong, and wanting to be noticed are powerful influences. Communication from parents does appear to play a role in adolescent behavior, and openness in communication may be considered a protective measure against possible use.
Some authors have stated that a major parental influence for the adolescent
in terms of peer influence is through the choice of friends. Adolescents
who associate with friends who use are very likely to use themselves.
And family variables may influence the choice of friends and thereby influence
the risk of drug use. Parental monitoring and drug use by parents
and other family members may have significant effects on the risk of adolescent
drug use. One important path of this influence is through the choice
of friends. Adolescents who come from families where alcohol and
other drugs are used are much more likely to choose friends who use drugs.
Thus, parents have powerful influence on their adolescents by their influence
on their choice of friends and their monitoring of the peer selection process
(Bahr et al., 1993)
Drop and discuss V:2-15 Bonding
Much of the resiliency literature focuses on the relationships or "bonding"
between family members and the youth. For example,
However, a good parent/adolescent relationship does not always protect
the child from substance use. If the parent, particularly the mother,
has a good relationship with the youth, and that parent uses substances,
the youth is more likely to use drugs. Female youth were more likely
to imitate paternal use and non-use of a substance if they had a good,
rather than a poor, relationship with their father. Additionally,
parental abstinence did not always ensure abstinence in the child.
A youth with a poor relationship with a non-using parent was as likely
to use substances as a using parent in a poor parent/adolescent relationship
(Andrews, 1994).
Conclude this section by stating that this is only a very brief look at the research in this area.
Explain that all of the research cited in the mini-lecture is referenced
in the literature found in the Resource Guide. There is also more
related research in the Bibliographies in the Resource Guide, and they
can access much more through the Internet addresses listed in the participant's
Resource Guide.
In this section of the training, we will discuss family culture.
Family Culture Exercise
There are many different family structures. Some examples include:
Directions (Small Group Exercise - 20 minutes)
Ask the participants to work in groups of 4-6 each at their tables to look at how families influence their attitudes about substance abuse.
- Have each participant draw the structure of their own families and describe how different culture identities affected their family. Include:
- geography- Then, call time after about 15 minutes. Have each group discuss how their families addressed the topics of
- religion
- ages & number of adults & children
- ethnic background
- economic status
- other
- tobaccoAsk participants in their groups to individually answer the following questions about tobacco, alcohol, and drugs.
- alcohol
- drugs
Drop and discuss V:2-16 Family Culture Questions (15 minutes)
Note: give examples of "explicit" and "implicit" norms.
1. What values did your family associate with tobacco, alcohol, and
other drugs?
2. What were your family's norms regarding tobacco, alcohol, and other
drugs?
3. How and from whom did you learn these norms?
4. Were the norms regarding tobacco, alcohol, and other drugs implicit
or explicit?
Facilitate a report out of each group's discussion, asking them to focus
on the "norms" regarding the topic that they were assigned.
LUNCH (60 minutes)