Prevention by social influence


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The proven effectiveness of universal prevention, a presentation by Peer van der Kreeft of De Sluetel about the EU-DAP programme, Unplugged.

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Prevention by social influence

  1. 1. 1<br />Prevention by social influenceProven effectiveness of universal prevention The Drug Education Forum16 november 2009 in London<br />Peer van der Kreeft<br />Lecturer drug issues and prevention, Faculty of Social Work and Welfare Studies at the University College Ghent<br />Head of prevention, De Sleutel,Belgium<br />
  2. 2. 2<br />Overview<br />Evidencebasedprevention<br />EU-Dapresults: effectiveprogramme<br />EU-Dapprogrammecomponents<br />Special attention to normative belief <br />UNODC, Mentor and EU-Dap: int’ldissemination<br />
  3. 3. 3<br />Balance …<br /> Interventions <br /> that large populations easily accept<br /> Interventions <br /> that have proven to be effective <br /> opinion base versus evidencebase<br />
  4. 4. 4<br />Action research: practicioners work together with researchers<br />
  5. 5. 5<br />What works?<br />RCT Randomized Controlled Trial<br />components from meta-analyses<br />… from systematic reviews<br />other research<br />Good practice (American Psychologists Association task force report °2005)<br />
  6. 6. 6<br />Problems with evidence <br />The evidence base is highly diversified and specialised<br />The evidence base is always „work in progress“<br />Continuous need for identifying unsatisfactory practice and for new evidence <br />Most evidence comes from a few countries<br />Not necessarily applicable in other countries or cultures<br />Uchtenhagen, ICAA Edinburgh 2006<br />
  7. 7. 7<br />Effectivity componentsaccording to meta-analysis Nancy Tobler 2000<br />Teacher training<br />Information about drugs<br />Include normative beliefs<br />Focus on specific influence based skills <br />Interactive delivery<br />Involve family and community<br />Cultural sensitivity<br />
  8. 8. 8<br />“RCT universal schoolbased prevention<br />… The first ever European Drug Abuse Prevention Trial EU-Dap has shown promising results. Funded by the European Commission, the project was implemented and cross-evaluated in seven countries, nine regional centres and 170 schools and involved 7 079 students (in a trial group and in a control group)….”<br />
  9. 9. 9<br />Not only effective but also safe: have lowest iatrogenic effects.<br />Iatrogenic effects: e.g. inadequate information, wrong target group, norm narrowing, facilitate access, werther effect<br />In the EU-DAP Unplugged programme no iatrogenic effects were detected.<br />
  10. 10. 10<br />
  11. 11. 11<br />The study sample at baseline (n=7079) °2004<br />
  12. 12. 12<br /><br />The EU-Dap Cluster Randomised Controlled Trial<br />Effectivity of Unplugged intervention after 2nd questionnaire (3 mths post interv) <br />Daily smoking 30% reduction*<br /> Recent drunkenness 28% reduction<br />Experimenting cannabis 23% reduction<br />The EU-Dap class programme has a preventive effect on early onset of drug use and on the transition of experimental to frequent use. The effect is bigger for boys than for girls.<br />*Daily smoking, recent drunkenness, any cannabis at this age are stronger predictors<br />
  13. 13. 13<br />Daily smoking<br />Any use of cannabis<br />Any episode of drunkenness<br />Changes in prevalence of past 30 days substance use between EU-Dap participants at baseline (n=7079), at the 3 months (n=6370) and at the 15 months follow-up (n=5541)<br />
  14. 14. 14<br />Daily smoking <br />
  15. 15. 15<br />Any drunkenness<br />
  16. 16. 16<br />Any cannabis<br />
  17. 17. 17<br />Programme components<br />Implementation guide<br />Workbook for the pupil<br />Cards for class<br />Handbook 12 lessons for the teacher <br />Teacher training<br />Three parent meetings <br />
  18. 18. 18<br />
  19. 19. 19<br />Normative belief<br />
  20. 20. 20<br />Normative belief workbookmanualcards<br />
  21. 21. Normative belief exercise<br />21<br />
  22. 22. Normative belief exercise<br />22<br />
  23. 23. 23<br />Parent meetings<br />
  24. 24. 24<br />Teacher training<br />Objectives of the 3 day training:<br />Information transfer<br />Social learning<br />Experimental learning<br />Learning to work on a positive and safe class climate<br />
  25. 25. 25<br />Assets of Unplugged<br />Feasibility of implementation: 12 lessons, in one semester<br />Balance of (1) intrapersonal, (2) interpersonal, (3) knowledge and attitude lessons<br />Correction of normative beliefs <br />Include non-health arguments, such as esthetical, financial, social risk, information on cannabis marketing strategy <br />Multi-cultural origin inside EU <br />Proven effectiveness<br />
  26. 26. 26<br />Risks and challenges<br />Less effective on girls – at that age <br />Training takes time and infrastructure<br />Cost of program: 200€/class<br />Follow up limited to 15 mths<br />Fading effect on smoking: booster intervention<br />
  27. 27. UnpluggeddisseminationItaly, Austria, Germany, Belgium, Sweden, Spain, Greece, CzechRepublic, Poland plus: <br />Lithuania<br />Romania<br />Russian Federation<br />Croatia<br />Kyrgizstan<br />Lebanon<br />Morocco<br />United Arab Emirates<br />Egypt<br />Jordan<br />Kuwait<br />
  28. 28. ICAA Estoril, October 2009<br />Fidelity vs. Fit<br />Surface Structure:<br />Language and idioms<br />Places<br />Product brands<br />Food<br />Music<br />…<br />Deep Structure:<br />Risk/ protective factors<br />Gender roles<br />Family and community life<br />Legal system<br />Norms and values<br />...<br />
  29. 29. 29<br />
  30. 30. 30<br />Int’l level deliveries<br />Implementationof the adapted version of Unplugged in new countries with each approx 16 schools, targeting ten thousands of pupils; process-evaluate this <br />A randomized controlled study in participating countries with at least 3.200 pupils for outcome evaluation <br />A team of trainers and managers to further disseminate the programme on a national base, with the existing schools and teachers as a firm starting point <br />
  31. 31. 31<br />Concrete steps national level<br />Identification of a national backup group to overview the adaptation, development, implementation and evaluation of the project.<br />Working with an operational project team to adapt Unplugged to meet the local needs and to identify trainers of teachers, in close cooperation with Mentor and EU-Dap. <br />Producing national translated and adapted programme material for training and for use in the school setting.<br />Identifying schools for implementation. <br />Teacher training followed by an agreed implementation period for the programme in agreed conditions.<br />Conducting a randomised controlled evaluation of the effectiveness in collaboration with EU-Dap, in 1 or more countries.<br />Disseminate to further schools with a view to national implementation of the programme.<br />
  32. 32. Timeframe international level<br />
  33. 33. © and €<br />The EU-Dap material, in all the language versions, is intellectual copyright of OED Torino. <br />This is an obligation by the EU that financed and powered the original version<br />EU wants it to be public domain<br />No financial obligations or profits may be liaised with the © on EU-Dap material<br />
  34. 34. 34<br />Overview<br />Evidencebasedprevention<br />EU Dapresults: effectiveprogramme<br />EU Dapprogrammecomponents<br />Special attention to normative belief<br />EU-Dapint’ldissemination<br />Thankyou,<br /><br /><br /><br />