Module 2: Prevention Overview

Purpose

Goal

Learning Objectives

• explain the CSAP definition of prevention;
• summarize 6 prevention strategies;
• Examine Risk and Protective Factors for Substance Abuse/Use.

Component                                                                         Visuals & Handouts

Transition                                                                             V2-1
P-1     Prevention                                                                 V2-2,3    HO2-1
P-2     Protective/Resiliency Factors                                     V2-4,5,6,7   HO2-2,3,4
P-3     Risk Factors                                                             V2-8,9,10,11  HO2-5,6
P-4     Transition
 

Materials Needed:     Transparencies, overhead projector, newsprint, markers, masking tape, crayons

Room Layout:     Small groups seated throughout the room

We will now examine some basic prevention principles and begin to place those principles and a social change theory within the context of substance abuse problem prevention programming with a faith community.

Drop V2-1: Learning Objectives.  Review and post.

Note:  There are several small group activities in this module.  Participants remain in the same groups for the entire module.
 
 

P-1 Prevention

2. Distribute a sheet of newsprint and several different colored markers or crayons to each group.  Ask participants to DRAW a picture of prevention.  There are to be no words on the newsprint.  The picture is to be a group effort. (10 minutes)

Note:  Markers and 2 sheets of newsprint should be placed on each table prior to this activity.

Drop V2-2: CSAP's Definition of Prevention
Prevention is described as those efforts that keep alcohol, tobacco, and other drug problems from occurring by reducing risk factors.

Engage participants in a discussion about prevention.  Include the following:

• a proactive process
• empowerment of individuals and systems
• life challenges
• healthy

Note:  Keep drawings posted for the remainder of the training.

• Participants may remark that their belief system, values, and spiritual traditions support this prevention concept.  Discuss with participants the perception that the faith community is a dynamic system and its influence in the larger community is part of the infrastructure of a comprehensive community approach to prevention.  Stress that prevention is comprehensive.

Note:  If participants do not comment on their belief system or values, facilitator should guide them to this discussion.

• Which traditions and values in your faith community encourage individual empowerment?
• How can a faith community help individuals and families meet today's challenges?
• How is your faith community a vital part of your larger community? (The large community includes the local neighborhood, city, town, county, etc.)
• What influence does your faith community have in the larger community regarding healthy behaviors and lifestyles?

Prevention Strategies

2. Prevention is comprehensive.  The following strategies have proven to be effective when used simultaneously, in a comprehensive community-based approach.  Note:  Reference Bonnie Bernard, An Overview of Community Based Prevention, published in Office for Substance Abuse Prevention Research Findings, 1988.  OSAP Prevention Monograph 3; included in the resources for this module.

3. Drop V2-3: Prevention Strategies  (10-15 minutes)

• Information
• Deals with facts
• Must be appropriate to each audience, and
• Should be used with the other strategies and geared toward specific needs.


Note:  Stress that these strategies are based on research findings, and follow a very specific order as will be seen in the "Diffusion of Innovation" chart later in this module.

Examples: Information about substance abuse is available through the National Clearinghouse for Alcohol and Drug Information: 1-800-729-6686.

Faith community leaders will need to know which information processes are appropriate for their particular faith community and which honor beliefs, values and traditions, cultural histories, age groupings, etc.

This training is an example of an information strategy.  Our aim is to give you useful information which you can use to maintain your substance abuse problem prevention  programs.  This next visual is an example of fact giving.

Note:  In January, 1994, the Clinton Administration released 13 federally funded public service ads for radio and television promoting sexual abstinence and the use of condoms.  These ads were designed specifically to appeal to youth.

• Life skills

This strategy enhance critical life and social skills which promote healthy lives and relationships.  These include such skills as refusal/resistance skills, decision making, making appropriate choices, communication, stress management, problem solving, etc.  Education processes include: sermons, seminars, study groups, parental training, premarital training, etc.

• Alternatives/activities

These promote a healthy environment and healthy living by providing opportunities for participation in activities which exclude substance abuse.  These may include mentoring, support groups, peer groups, parent skills training, and job training.  Such activities can also include outdoor and recreational activities and rites of passage issues which many spiritual traditions build on.  Spiritual leaders may want to begin making correlations between rites of passages within a given spiritual tradition and how this impacts healthy choices for individuals.  These rites may include formal rites such as a baptism ritual, a bar/bas mitzvah, confirmations, marriage rites, initiation into adulthood, sweat lodges, and numerous other rituals.  There are other activities that structured faith communities provide, such as fellowship meetings, etc.

Note:  Stress that research shows that attendance at religious activities, regardless of the religious denomination, acts as a protective factor against substance abuse problems.

According to research done by Nancy Tobler, although all of these strategies are important and must be included in a comprehensive program, providing substance abuse free alternatives is the strategy which gives the greatest results in Substance abuse prevention.

• what is legislated in the larger community, such as not selling liquor and tobacco to minors, and
• from the faith community's tradition, such as prohibiting the use of alcohol as a moral principle.  Note:  Muslims, Mennonites, and Mormons all prohibit the use of alcohol by their faith community members.

 

 
 
 
 
 
 
 

Note:  Remind participants that social policies are frequently local, state, or federal laws.  Warning notices on cigarettes are an example of social policy.

Whatever one's spiritual tradition, it is important that clear and consistent messages be given.  It is also appropriate to address the need to change social policies -  religious and secular.  A key question to ask is:

 
Does this social policy contribute to the empowerment of individuals and systems, and the creation of a healthy environment?
• Community Mobilization

It is important to involve representatives from all segments of the targeted community.

Ask participants to identify gate keepers and components of the Faith Community that should be involved in substance abuse prevention.

Note:  Gate keepers are those individuals in a community who make a difference and who have some degree of control.  Example: police make a difference by enforcing the law.
 

• Intervention

Design and employ methods to intervene as early as possible with individuals at risk of substance abuse use/abuse.  Frequently, individuals will turn to the faith community in times of life crisis.  Hot lines, referral systems, drop-in centers, SAP, EAP, and CAP are examples of early intervention strategies.

SAP = Student Assistance Programs

EAP = Employee Assistance
Programs

CAP = Church Assistance Programs

Ask:
What intervention programs do your faith communities have in place?
 

• These strategies have proven successful in prevention programming.  It is important that they be used simultaneously.

• Ask participants to identify the prevention strategies used in their substance abuse prevention programs.
• Ask participants to identify strategies which they feel their programs need to utilize in the future.

P-2     Protective/Resiliency Factors (15-20 minutes)

Notes:  Discussing protective/resiliency factors before risk factors models a proactive approach to prevention planning.

Later in this section, there is a mind mapping activity.  The purpose of this activity is to enable participants to identify real life protective factors which exist within their faith communities.

Some participants may find it helpful to discuss general health protective factors prior to substance abuse protective factors.  For example, aerobic exercise is a protective factor for heart disease.

2. Give a brief overview of some of the research on these factors to set the tone:

3. There have been various studies conducted in the United States over the last 10 years on what is referred to as risk and protective factors.  Research has shown that adults who don't use or misuse alcohol, tobacco, and other drugs shared many of the same protective factors when they were young.  The following is a summary of this work.

Note:  Researchers include: Hawkins and Catalano, Garmezy, Brooks, Baumrind, and Benson.

4. Drop V2-4: Protective/Resiliency Factors.
Protective/Resiliency factors are those personal and environmental elements of life that contribute to healthy choices and healthy behaviors.

Note:  The protective factors listed on HO2-2 are based on the work done by Hawkins and Catalano.  Another protective factor reported by the Search Institute in Minneapolis, MN is religious involvement.

5. Four specific areas have been identified where these protective factors can occur:

• Family
• Peers
• School
• Community

 

• Distribute HO2-2: Protective/Resiliency Factors.

Some of the protective/resiliency factors identified include:

• Family
• Seeking prenatal care.
• Parents develop close bonding with children.
• Education is valued and encouraged.
• Stress is well managed.
• Quality time is spent with children and as a family.
• There is a high warm/low criticism parenting style rather than an overly authoritarian or overly permissive style.
• The family is nurturing and protective - providing safety.
• There are clear expectations for behaviors
• Supportive relationships with caring adults beyond the immediate family, such as a teacher, scout leader, youth minister, church leader, mentor, etc. are encouraged.
• All family members share responsibilities according to age development and capabilities.

• Peers
• Involved in healthy, drug and alcohol free activities.
• Youth respect authority; adults respect youth.
• Bonded to conventional groups, such as church youth groups, 4-H, Future Farmers, etc. as opposed to unconventional groups such as gangs.
• Appreciate and value the unique talent that each person brings to the group.

• School
• Expresses high expectations.
• Encourages goal setting and achieving those goals.
• Staff views itself as nurturing caretakers.
• Encourages a sense of doing good for the sake of others; a sense of giving and cooperation.
• Provides leadership and decision-making opportunities.
• Fosters active involvement of students.
• Trains teachers in social development and cooperative learning.
• Involves parents in a meaningful manner.
• Provides alcohol/drug free alternative activities.

• Community
• Enforces public policy which supports non-use among youth.
• Provides access to resources such as housing, healthcare, childcare, job training, employment and recreation.

Transition: Another way to think about protective factors is to look at those factors, assets, which promote positive teenage development - resiliency.

Note:  Inclusion of this material is OPTIONAL and dependent on the amount of time you have available.  This information is in the participant guide.

Assets  (5 minutes)

The assets shown here can equip adolescents to make wise choices.  The average student has only fifty percent of the external assets and sixty percent of the internal assets.  As youth get older and face tougher choices, the number of assets tends to decrease in the key areas of positive values, control, and social support."
 

EXTERNAL Protective/Resiliency Factor

INTERNAL Protective/Resiliency Factors

1. Family support 2. Parent(s) as social resources 3. Parent communication 4. Other adult resources 5. Other adult communication 6. Parent involvement in school 7. Positive school climate 8. Parental standards 9. Parental discipline 10. Parent monitoring 11. Time at home 12. Positive peer influence 13. Involved in music 14. Involved in school extra-curricular activities 15. Involved in community organizations or activities 16. Involved in church or synagogue or mosque 17. Spirituality

1. Achievement motivation 2. Educational aspiration 3. School performance 4. Homework 5. Values helping people 6. Is concerned about world hunger 7. Cares about people's feelings 8. Values sexual restraint 9. Assertiveness skills 10. Decision-making skills 11. Friendship-making skills 12. Planning skills 13. Self-esteem 14. Positive view of personal future 15. Spirituality

2. Do not read these verbatim.  Give participants a few minutes to read the list over.
Ask:
What relationship do you see between these two lists?

Possible response:
Positive involvement with parents/adults will help to develop and enhance internal assets.

Note:  Ask participants to read the Case study (HO2-4) during the lunch break.
 

Lunch Break

Case Study (15 minutes)

2. Distribute HO2-4(a) and HO2-4(b):  Case Study.

3. Divide the community into small groups of 5 - 10.
Each group should have newsprint posted which has their assigned protective factors listed.

Participants should identify the examples from the case study and record them under the correct protective factors.

For example, "The community center offers a wide variety of weekly free events.  These include adult education classes, health awareness programs, parenting education classes, and substance abuse free activities geared toward youth." could be listed under community: provides access to resources.

Note:  Participants may find that an example of a protective factor may fit several categories.  For example, an activity such as Project Graduation could be listed under either of the following protective factors:

• Peers involved in healthy, drug and alcohol free activities  or
• Schools provide alcohol/drug free alternative activities.
• Ask participants to check off on the newsprint those protective factors which their faith communities actively promote at this time. Note:  An option to this step is to use the mind mapping activity.
• Small groups report out.  Add to the group lists as needed. Note:  Use "Case Study Worksheet" HO2-6.

Protective Factors Activity:  Mind Mapping (15 minutes - OPTIONAL)

2. Ask one person to write the words Protective/Resiliency factors within the faith community at the top of the sheets and to draw the trunk of a tree.

Drop V2-6

Notes:  Mind mapping is a brainstorming activity which is visual and active.  This appeals to visual and kinesthetic learners.  Traditional brainstorming techniques appeal more to audio learners.
The tree trunk can be replaced by any central symbol such as a circle.  The tree diagram shown has been duplicated in V-6.

It may save time to predraw the tree on newsprint with individual protective factors "branches".  Participants then add their examples of specific protective factors.

Participants may find a demonstration helpful.  Emphasize that this is a group activity: participants add onto each other's drawings.  No one person should be drawing a complete set of branches.

3. Each participant draws branches from the main trunk to identify existing protective/resiliency factors within their own faith community as per HO2-2.  For example, a family which is nurturing and protective is a documented protective factor.

Possible initial branches:
A. a family which is nurturing and protective
B. peers involved in healthy, drug and alcohol free activities
C. schools which involve parents in a meaningful manner

From these initial branches, list related activities.  For example, "parent training classes" are an substance abuse problem prevention activity which would be listed under a family which is nurturing and protective.

Examples of branches:
A.     a family which is nurturing and protective
        "parent training classes"

B.    peers involved in healthy, drug and alcohol free activities
        " Project Graduation"
        " First Night"
        " Friday Night Live"

C.     schools which involve parents in a meaningful manner
        "an active Parent Teacher Organization"

As more and more branches are added, lines can be drawn between branches to show how these protective factors are interrelated.

Transition:  Drop V2-7:  The Protective Factor Circle.

P-3     Risk Factors (10-15 minutes)

Note:  Some participants may find it helpful to first discuss general health risk factors.  For example, a high fat diet, obesity, and limited exercise are risk factors for heart disease.

Drop V2-8:     Risk Factors.
Risk factors are those conditions which place individuals at greater risk of developing problems with alcohol, tobacco, and other drugs.

Identifying and understanding risk factors assist prevention program planners and providers to target certain behaviors and conditions for change.

Drop V2-9:     Risk Factors.
Risk factors do not predict future problems with alcohol, tobacco, and other drugs.

2. Distribute HO2-3: Risk Factors
Note:  Reference Hawkins and Catalano.

• Family
• Family management problems which include: unclear expectations for behavior, lack of monitoring and supervision, inconsistent or harsh discipline, lack of bonding and caring, conflict between the parents/caregivers
• Encouraging or ignoring teen use of alcohol and other drugs
• Parent/caregiver's use/abuse of alcohol, tobacco, or other drugs
• Low expectations of children's success
• Family history of alcoholism
• Parents involve youth in the parental use or misuse of substances: Light my cigarette, get me a beer, etc.
• Peers
• Early anti-social behavior such as: vandalism, bullying, or meanness as a regular behavior pattern
• Alienation or withdrawal from conventional groupings and activities; rebelliousness which manifests itself beyond normal human stages of development and growth
• Early first use of any substance
• Greater influence by and reliance on peers rather than on parents for advice and guidance
• Friends who use alcohol, tobacco, and other drugs
• School
• Negative school climate: for example, attitudes which are manifest in such statements as School is hard, you will never learn, you are a slow learner, etc.
• School policies, rules, regulations not defined or not enforced uniformly
• Transitions between schools:  for example, from elementary school to middle school or from middle school to high school
• Academic failure on a consistent basis
• Lack of student involvement with curricular and extra-curricular activities
• Labeling and identifying students as at risk or high risk students
• Truancy and suspension
• Community
• Economic and social deprivation which includes: poverty, lack of adequate housing, poor healthcare, a sense of no future or improvement in quality of life
• Low neighborhood attachment and community disorganization: no involvement with others in the geographic region, little or no community leadership
• Lack of employment opportunities
• Lack of opportunities for youth to become involved with the community
• Easy availability of alcohol, tobacco, and other drugs
• Community attitudes, practices, policy or laws which are favorable toward Substance abuse use and misuse

Deficits

2. Drop V2-10: Deficits.
"The deficits listed are associated with risky behaviors such as frequent alcohol use, attempted suicide, and high levels of sexual activity...Four deficits strongly increase as students get older:  time alone at home, drinking parties, stress, and sexual abuse.  This parallels the corresponding decrease of key assets...Communities need to consider important gender differences...Girls, for example, are much more likely than boys to experience physical abuse, sexual abuse, and stress.  Boys, on the other hand, are much more likely than girls to develop self-serving values, with a parallel resistance to pro-social values."

3. Do not read this visual aloud to the participants.  Give them a few minutes to read the information and then ask for comments.

Case Study Activity: Distribute HO2-6  (15 minutes)

2. Participants should identify the examples from the case study and record them under the correct risk factors. Participants may find that an example of a case study risk factor may be placed with one or more risk factors.

For example, "The drop-out rate throughout the school system has increased over the past year." would be listed under School: Academic failure on a consistent basis.

3. Have small groups report out.  Add to the group lists as needed.

Small group activity (10 minutes)

2. Each group should now prioritize its top three protective factors and its top three risk factors.
Note:  Each participant has a total of 6 votes: 3 for protective factors, 3 for risk factors.  Each factor is read and participants vote for their choices.  A tally of the votes cast is recorded next to each factor.  The protective factors and the risk factors with the most votes become the prioritized top three protective or risk factors.

3. Small groups report out.

4. Facilitate a brief discussion comparing the challenges and opportunities that were identified in Module 1 and the prioritized protective/resiliency and risk factors.

Shifting the Balance

When you plan a prevention activity/program, it is important to focus on this shift and to incorporate the prevention strategies which we previously discussed. Note: The presence of an active faith community has been shown in the research as a positive influence and a key to reducing risk factors and enhancing protective/resiliency factors.  The research has further shown that participating with a faith community on a regular basis is in itself a protective factor.

Note: Although there are accepted protective/resiliency and risk factors which are found in all cultures, socio-economic groups, etc.  the prevalence of certain factors will vary from culture to culture and denomination to denomination of faith communities.

P-4  Transition:  Now that we have looked at some of the basics of substance abuse problem prevention, we are going to look at the process which is involved when individuals are faced with a change.  Think about the history of substance abuse problem prevention as we know it.  Years ago, many people were unconcerned about alcohol, tobacco, and other drug use/abuse problems.  Accepting, supporting, and practicing substance abuse problem prevention has been a long term process.  Getting individuals, families, cultures, and society to change hasn't been easy.