GOOD PRACTICES AND INTERVENTIONS FOR THE PREVENTION OF ALCOHOL USE AMONG JUVENILES IN THE NETHERLANDS: NATIONAL INVENTORY

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1 GOOD PRACTICES AND INTERVENTIONS FOR THE PREVENTION OF ALCOHOL USE AMONG JUVENILES IN THE NETHERLANDS: NATIONAL INVENTORY Jessica van den Toorn, Harrie Jonkman, Majone Steketee, Claire Aussems Verwey-Jonker Institute, the Netherlands Introduction Widespread alcohol abuse among juveniles has a serious impact on society, the economy and public health. In order to obviate the consequences of alcohol abuse, state and local authorities have adopted many kinds of prevention programs, which vary considerably among countries. In some European countries, preventive interventions have been broadly implemented for many years, and in some cases they have been thoroughly evaluated scientifically. In other countries, preventive interventions have been fewer, and efforts to evaluate them have been less scientific. In this paper we draw up an inventory of preventive programs in the Netherlands on the meso (school and neighbourhood) and micro (family and individual) level aimed at alcohol use among juveniles in European countries. At the end we describe two best practices in more detail. This report, along with the other national reports within the AAA prevent project, should enable policy-makers to discern which preventive interventions have proved effective or promising in the various countries and should indicate best practices targeting the prevention of alcohol consumption among juveniles. 1. Alcohol prevention programs at the meso and micro levels in the Netherlands: inventory of good practices (two pages) According to the Dutch government too much alcohol is especially harmful for adolescents and therefore she wants to reduce the alcohol use among students. 1 Through prevention, relief work and rules about the production and sale of alcoholic beverages the government tries to limit the alcohol consumption of adolescents, delay the age on which they start drinking, decrease the physical and psychological dependence on alcohol and decrease the harmful consequences of alcohol abuse in special situations (for example at the workplace or in transport). 2 Starting point of the Dutch government is that only a coherent and integral approach will be successful to combat alcohol abuse among adolescents. 3 Policy interventions for adolescents are primary focussed on information (on schools), restrictions of the availability, strict rules 1 Hosman, C. H. M Prevention and Health Promotion on the International Scene: The Need for a More Effective and Comprehensive Approach, Addictive Behaviors, vol. 25, pp / Laar, M. W. van, Cruts, A.A.M. Verdurmen, J.E.E., et al Nationale Drug Monitor Jaarbericht 2007, Utrecht, Trimbos Instituut. 2 Hasselt, van, N. (red) (2010). Preventie van schadelijk alcoholgebruik en drugsgebruik onder jongeren. Utrecht: Trimbos-instituut. 3 Busch, M., Kuunders, M., & Schoenmakers, C. G. (2010). Wat wordt beoogd met preventie gericht op alcoholgebruik? Bilthoven: RIVM. Volksgezondheid Toekomst Verkenning, Nationaal Kompas Volksgezondheid. Bilthoven: RIVM, preventie-gericht-op-leefstijl/alcohol/doel/retrieved 19 juni,

2 and advertisement restrictions. The national alcohol policy is in practice shaped by the municipalities. The local and regional health services for addiction care execute prevention project on the local and regional level, often in cooperation with school, fertilities and entrepreneurs. (http://www.nationaalkompas.nl/preventie/gericht-opgezondheidsdeterminanten/preventie-gericht-op-leefstijl/alcohol/preventie-gericht-opalcoholgebruik-samengevat/). The national departments of BZK (international affairs), VWS (health, welfare and sports) and the department for Youth and Family developed a manual to help municipalities in the formulation, implementation and regulation of their policy. As notices before, besides stricter policies and regulations the Dutch government invests in campaigns and information (http://www.rijksoverheid.nl/onderwerpen/alcohol/jongeren-enalcohol) Indeed, adolescents and their parents should be aware of the risks of alcohol. Different organizations like the Veilig Verkeer Nederland (Safe Traffic the Netherlands) and STAP (the Dutch institute for alcohol policy) offer information. Each organization has a different approach, target group and setting.since early 2008 the Trimbos Institute has been appointed as the national knowledge institute for alcohol. Trimbos coordinates all the prevention campaigns conducted by municipal health services and addiction care organisations. The Trimbos Institute also runs an alcohol helpline and develops and executes alcohol campaigns for youngsters. In most of their campaigns, like Raising campaign smoking, drinking and blowing and Alcohol and Parenting the institute emphasizes the crucial role of parents in the drinking behaviour of young people. (http://www.trimbos.org/onderwerpen/alcohol-anddrugs/prevention-of-alcohol-use). Multiple studies have shown that stricter rules at home can postpone the use of alcohol and decline the chance on problem drinking. 4 The campaigns of the Trimbos Institute show a recent shift in the Dutch culture. Organizations used to promote the message to introduce children to alcohol in a safe environment. The reasoning behind this was that the idea that children would learn to handle drink more sensibly, if alcohol was first introduced in a home setting. However, in practice it turned out that when teenagers are allowed to drink at home, they take this as permission to carry on drinking elsewhere. This insight explains the fact that parents and other family members are closely involved in most of the intervention programs for youngsters in the Netherlands. Another important ally of the Dutch government in the fight against alcohol abuse is the school. Already since 1990 the project the Healthy School and Drugs of the Trimbos-institute is used on secondary schools (12-16/18 years). The project offers courses about drugs and guides students in close consultation with the parents- in the case of alcohol abuse. STAP (part of the Dutch Institute for Alcohol Policy) offers a special website with tips, information and ideas for everyone who commits to an alcohol free school. The Netherlands has two big databases in which preventive and indicated interventions are presented, described and judged based on their quality, effectiveness and coherence. These bases are: a) The I-database of the Loket Gezond Leven (http://www.loketgezondleven.nl/interventies/i-database/) 4 Van der Vorst, H. (2007). The key to the cellar door: the role of the family in adolescents alcohol use. Nijmegen: Radboud Universiteit Nijmegen. / Vet, R., Van den Eijnden, R. (2007). Het gebruik van alcohol door jongeren en de rol van ouders: Resultaten van twee metingen. Rotterdam: IVO. 2

3 b) The Database of Effective Youth Interventions of the Netherlands Youth Institute (http://www.nji.nl/ecache/def/1/21/478.html) Based on these databases we constructed an overview of the most important alcohol prevention programs found in the Netherlands, described per level of intervention (individual, family, school, community, and multi-component). We only included intervention programs, which: a. explicitly include the prevention of underage drinking among their aims, even if other issues are targeted (e.g. drug use or abuse, etc.). b. are developed in accordance with a manual, text or defined guidelines, in order to make its characteristics and implementation clearly understandable and to enable the program/intervention to be replicated. The interventions can be divided into three forms ): 1) Universal prevention, for the total population without alcohol problems. 2) Selective prevention, for specific risk groups with an enlarged chance on alcohol issues, like children with addictive parents. 3) Indicated prevention, for people with problematic alcohol use or first signs of use. Most youth interventions in the Netherlands are based on universal prevention. The second and third type are mainly developed for adults. Overall, the country knows a variety of prevention programs on all levels described above (individual, family, school, community and multi-component). As mentioned before, a lot of them involve the family and the school. 3

4 1. Individual level Intervention name Halt Programme (Halt-afdoening Alcohol)/ Boeteof kanskaart (Penalty or chance carte) Type 5 Age targeted Selective years old Brains 4 Use Indicated years old Period 6 Dimension 7 Main results Sources In more than half of the Halt regions this intervention is used In 2010 B4U was used in most juvenile justice institutions and in some youth care institutions in the Netherlands. Not yet known. The evaluation study is started in The intervention is effective in reducing drug use. 725B6072-E081-2F5B-420E8880C510A27F/index.cfm Lodewijks, H.P.B. (2006). Brains 4 Use: an addiction programme for youth in a juvenile justice institution. Connections, 19, pp These two individual programs both focus on a specific problem group: juveniles who were arrested by the Dutch police (the Halt programme) and youth in a juvenile justice institutions (Brains 4 Use). The Brains 4 Use program has been evaluated and has proven to be effective. The Halt- Programme is evaluated in The results are expected any moment. 5 Universal (for everyone in an eligible population), selective (for members of population subgroups at higher risk), or indicated (for those with existing alcohol problems). 6 Year when the intervention was started. 7 Number of individuals, schools or communities involved. 8 Articles, reports, documents, etc. 1

5 2. Family level Intervention Age targeted Period Dimension Main results Sources Triple P; Positive Parenting 0-16 years old In the Netherlands: Program 2004 International intervention and five different levels Parents report a decline in behaviour problems and improvement of their raising skills directly after Triple P, 6 months later and 12 months later. Blokland, G. (2007). Positief Opvoeden voor al ouders. Utrecht: NJI. Graaf, I. de, Speetjens, P.A.M., Wollf, M.S. de Smit, H.F.E. (2008). Effectiveness of the Posit Parenting Program Triple P on behavioural pro in children: meta-analysis of randomized trials haviour Modification, 32, Graaf, I. de, Speetjens, P.A.M., Wollf, M.S. de Smit, H.F.E. (2008). Effectiveness of the Posit Parenting Program Triple P on parenting: a me analysis of randomized trials. Family Relations 57(5), Nowak, C. & Heinrichs, N. (2008). A Comprehe Meta-Analysis of Triple P-Positive Parenting Pr Using Hierarchical Linear Modelling: Effectiven and Moderating Variables. Clinical Child and Family Psychology view, 11(3), Sanders, M. R. (1999). Triple P - Positive Paren Program: towards an empirically validated mu level parenting and family support strategy for 2

6 Homeparty Hard to reach parents (both natives and minorities) with a child between years old 2004 Not known A process evaluation shows that the intervention is suitable for parents who are poorly reached by the regular prevention activities. prevention of behaviour problems in children. cal Child and Family Psychology Review, 2, 71 Bolier, L. & Riper, H. (2004). Procesevaluatie Homeparty s. Utrecht: Trimbos-instituut. Riper, H., Bolier, L & Elling, A. (2005). The Homeparty: Development of a low threshold i vention for not yet reached parents in adole substance use prevention. Journal of substanc use, 10 (2-3), Naaborgh, L. & Weingart, S. (2009). Homepart ten in hokken voor ouders'. Alcohol en opvoed Handleiding, pilotversie. Utrecht: Trimbos-inst These two family intervention programs differ considerably. First of all, the Homeparty program focuses on a quite specific target group, namely parents who are hard to reach. During a group meeting in their own homes, parents are provided with advice about dealing with alcohol and drugs use of their children. The process evaluations show that the intervention matches the target group, but does not provide us with knowledge about the effectiveness of the program. The Triple P; Positive Parenting Program stimulates positive parenting and therewith a decrease in the behaviour problems of the children. Alcohol use is seen as one of these behaviour problems. 3. School level Intervention Age targeted Period Dimension Main results Sources Preventie Alcoholgebruik Scholieren (PAS- Prevention Alcohol use juveniles of years old and their parents Three years 59% of the secondary schools in the Netherlands make The analyses show that PAS can delay the start of weekly Koning, Vollebergh, Smit, Verdurmen, van den Eijnden, ter Bogt, et al. (2009). Preventing heavy alcohol use in adolescents (PAS): cluster randomized trial of a parent and student intervention offered separately and simultaneously, Addiction, 104, p Manuals or website: There are manuals available and a Power-Point presen- 3

7 students)) De gezonde school en genotmiddelen (The healthy school and drugs) Primary school, secondary school and MBO Since 1990 use of this intervention.. 30% of the primary schools and 65% of the secondary schools (heavy) drinking by 34 months if both juveniles and parents are involved in the interventions described. Only the combination of both interventions has proved to be effective. Students have a less positive attitude towards drug use and feel they are better able to resist using when offered. In addition, there are more conscious of social influence on their drug use. Students drink less tation and brochures for parents. Cuijpers P, Jonkers R, Weerdt I de, Jong A de. The effects of drug abuse prevention at school. Addiction 2002;97:

8 (Prepared in Time) Op Tijd Voorbereid Intermediaries: parents and teachers Target Group: 11/12 years old (last grade of primary school) 2009 In the intervention has been use on nearly 400 primary schools in five regions. alcohol and start at a later age. Knowledge of pupils increase by the e-learn program and the knowledge of parents increases by the parent meeting. Parents are more conscious about their effect on the alcohol consumption of their child. ter Huurne, E. (2006). Een onderzoek naar het gebruik van e-learning bij genotmiddelenpreventie voor het basisonderwijs. Masterscript. Universiteit Twente en Tactus Verslavingszorg, Enschede. ter Huurne, E. (2008). Kwalitatief onderzoek naar de opvatting van gemeenten over de terugkoppeling van het project Op tijd voorbereid middels het evaluatierapport. Unpublished Manuscript. Tactus Verslavingszorg, Enschede. Kemna, L. (2009) A study into the possibilities of e-learning and substance use prevention-interventions for intellectually disabled adolescents. Unpublished manuscript. Universiteit Twente, Tactus Verslavingszorg, Enschede en Aveleijn SDT, Borne. Sprakel, I. (2008). Een onderzoek naar het gebruik en de waardering van het e-learning project Op tijd voorbereid onder docenten van groep 8. Unpublished Manuscript. Universiteit Twente en Tactus Verslavingszorg, Enschede. These three school level programs are quite similar. They all try to increase the knowledge of children about alcohol and all three actively involve the parents. Also, all three programs have been evaluated and show positive results. A difference can be noticed in the target group. PAS focuses specifically on secondary school pupils, Prepared in Time on primary school pupils and The Healthy School and Drugs targets the whole range from primary school till intermediate vocational education (MBO). In general, school interventions reach many adolescents with relatively low costs and can add to the knowledge and awareness. However, school interventions are often only effective in decreasing or delaying alcohol consumption if they use interactive methods, involve the parents and try to influence the school environment as a whole. 9 9 Hasselt, van, N. (red) (2010). Preventie van schadelijk alcoholgebruik en drugsgebruik onder jongeren. Utrecht: Trimbos-instituut. 5

9 4. Community level Intervention Age targeted Period Dimension Main results Sources Open and Alert: alcohol and drug prevention in risk settings (mentally handicapped, youth work, youth aid) In 2007 half of the organizations (n=5) for addiction care used Open and Alert. In intermediaries were reached. The intervention is useful, workable, successful and relevant for professionals of youth prisons. The intervention won the 'Best Practice Award for Health in Prisons 2009'. eschrijving%20open%20en%20alert.pdf Van der Veen, C. & Van Leeuwen, L. (2009). Open en Alert. Alcohol- drugspreventie in de justitiële jeugdinrichting. Resultaten procesevaluatie. Utrecht: Trimbos-instituut. Hilderink, I., & Bransen, E. (2010). Voorkomen van problematisch middelengebruik door jongeren met een licht verstandelijke beperking. Een interventieprogramma. Utrecht: Trimbos-instituut. Barcode: dealing with alcohol and drugs in the Intermediaries: employees in the hotel and catering indus In professionals were trained in 15 munici- With a few adaptations the intervention also works for the light mentally handicapped target group. A process evaluation in three enterprises shows Bolier L, Van Leeuwen L, Sannen A, Planken M. Barcode - omgaan met alcohol en drugs in de horeca-. Trainersmap voor preventieprofessionals van instellingen voor verslavingszorg en GGD'en Utrecht, Trmibosinstituut. 6

10 hotel and catering industry (Barcode: Omgaan met alcohol en drugs in de horeca) try. Target group: young adolescent going out (16-26 years old) palities that employees feel more equipped dealing with alcohol abuse after the course. The programs Open and Alert and Barcode focus on the intermediaries working or dealing with adolescents in youth prisons and in the hotel and catering industry. The programs focus both on policy and expertise enhancement. In both cases professionals declare to feel more equipped to deal with alcohol abuse after the program. 5. Multi-component Intervention Alcohol reduction Youth in the Achterhoek (Alcoholmatiging Jeugd in de Achterhoek) Age targeted years old Period Dimension Main results Sources 2005 The intervention focuses on places where youth may interact with alcohol: at home, on the street, at school, at sport clubs, clubs and bars and 1. The percentage of adolescents drinking alcohol has decreased between 2003 and Effect analyses show that the intervention has caused changes in Hoeven, H. (2008). Gegevens over alcoholgebruik van jongeren in 2003 en 2007 in de regio van GGD Gelre-IJssel. Apeldoorn: GGD Gelre-Ijssel Izeboud, C., Rover, C. de, Vlaming, R. de, Haveman-Nies, A. (2008). Het project Alcoholmatiging Jeugd in de Achterhoek: de ontwikkeling van een complexe interventie. Tijdschrift voor Gezondheidswetenschappen, 86, 7, Vlaming, R. de, Rover, C. de, Izeboud, C., Jansen, S., Wit, I. de, Haveman-Nies, A. (2008). Evaluatie van Alcoholmatiging Jeugd in de Achterhoek : verandering in perceptie van ouders op het alcoholgebruik van jongeren na één jaar. Tijdschrift voor Gezondheidswetenschappen, 86, 7,

11 Multidimensional Family Therapy, MDFT (Multidimensionele Familietherapie) years old, who drink too much and/or use drugs and in addition often suffer from mental disorders In Europe since 2003 youth work. There are 30 teams in the Netherlands working with MDFT the perception of parent on the alcohol use of adolescents. Among other things, parents talk more about alcohol with their children. MDFT has been found effective in seven great research studies E. Kaptijn en K. Mos (2008). Multidimensionele familietherapie, Een evidence based intensieve gezinsmethodiek voor gezinnen van jongeren met complexe meervoudige problematiek' ('Gezinsinterventies, aan de slag met problematische opvoedingskwesties', isbn: ) K. Mos e.a. (2011), Wegwijzer voor toepassing van MDFT in justitiële jeugdinrichtingen en aansluitende ambulante zorg. Leiden: MDFT Academie H. Rigter e.a. (2011), Wegwijzer voor toepassing van MDFT in jeugdzorgplus en residentiële jeugdzorg met aansluitende ambulante zorg. Leiden: MDFT Academie Rigter H, Pelc I, Tossmann P, Phan O, Grichting E, Hendriks V, Rowe C. INCANT: a transnational randomized trial of Multidimensional Family Therapy versus treatment as usual for adolescents with cannabis use disorder. BMC Psychiatry 2010; 10: 28. 8

12 In this category we find two very diverse intervention programs. Alcohol reduction Youth in the Achterhoek is a local program which 1) focuses on the habitat of adolescents, 2) uses a brought, holistic approach, 3) is based on cooperation between different local professionals and parents, 4) is based on integral policy on the municipality level, 5) associates with national policy and 6) is long term. Per setting (home, street, school, sports, hotel and catering industry, youth work) activities are organized focusing on education, rules and maintenance. Several studies show that this program has caused a decline of alcohol consumption in the Achterhoek and a different perception of alcohol abuse among youngsters among parents. The second program on this intervention level, the Multidimensional Family Therapy, in a national program. Its focuses specifically on under aged youngsters, who drink too much and/or use drugs and often suffer from mental disorders. This treatment program includes four life domains of the adolescents: the person itself, the parents, the family and extern systems like school, work and leisure. Seven different studies found MDFT to be effective on the decline of problem behaviour under which alcohol consumption. 9

13 Accreditation of the inventory All interventions included in the database of the Netherlands Youth Institute, in which most of the programs above are described, have been assessed and accredited. Accreditation occurs on three levels of effectiveness: theoretically sound (level I), probably effective (level II) and established effective (level III). Each level has its own listing of accreditation criteria, which can be found on the website. The criteria are linked to the intervention's conceptual framework, the soundness of its methodology, its practical implementation, and any available research on its effectiveness. Theoretically sound means that the intervention is at least described in detail and that it is theoretically likely that the intervention will contribute to achieving the desired goal(s). According to the accreditation system an intervention is effective if research shows that actual goals were achieved more effectively through this intervention than with other interventions or without any deliberate action. If limited research has been conducted or the available research has limited evidential value, positive results will indicate probable effectiveness. If more research or research with more evidential value is available an intervention with positive outcomes is likely to be labelled with established effectiveness. Accreditation is granted for a maximum of five years, after this period a re-assessment is conducted. The table below shows the accreditation of the above described programs (level I, II or III). Intervention program Accreditation Individual Halt Programme Level I Brains 4 use Level III Family Tiple P Level I Homeparty Level I School PAS- Prevention Alcohol use students Level II The Healthy School and Drugs Level I Prepared in Time Level I Community Open and Alert Level I Barcode Level I Multi-component Alcohol reduction Youth in the Achterhoek Level I MDFT- Multidimensional Family Therapy Level III The table makes clear that most of the intervention programs are described in detail and likely to be effective, however, they are not (yet) proven to be effective. Region and local prevention activities which are not present in the inventory As our national experts point out, we should bear in mind that the above described overview is based on two specific databases. Reason for this has been the criteria that interventions a) explicitly include the prevention of underage drinking among their aims, even if other issues are targeted (e.g. drug use or abuse, etc.) and b) are developed in accordance with a manual, 1

14 text or defined guidelines, in order to make its characteristics and implementation clearly understandable and to enable the program/intervention to be replicated. There are, however, multiple interesting interventions which are not shown in these databases, because there is for example no money for research, interventions are still researched or because there is no time to make a detailed description which is necessary to be considered. One of the experts emphasizes that people who work in those local initiatives are often frustrated by the huge amount of time an application for the databases costs. STAP, for example, constructed a special website AlcoholvrijeOmgeving.nl (alcohol free environment) on which diverse local, practical examples of initiatives for 16- adolescents are presented. (http://www.stap.nl/omgeving/home/over_deze_website.html) The initiatives are described for the domains school, home, going out and holiday and leisure. The difference with our inventory is that these examples are more tips and advises, than established interventions yet. The website provides for example tips for schools who are wondering whether they should tolerate alcohol on school parties. Another example of an intervention that is not in our inventory is the PREVENTURE program. The PREVENTURE program screens a school population on pupils who already drink alcohol in combination with a high risk personality profile (Anxiety Sensitivity, Sensation Seeking, Impulsivity and Negative Thinking) and offers them a tailored intervention based on Cognitive Behaviour Therapy (CBT) and motivational interviewing. The intervention is implemented at 15 high schools in the Netherladns and consitst of two group meetings of 90 minutes. The Trimbos-institute is evaluating the effects at this moment. The first results are expected in The experts also mentioned different regional, integral prevention approaches. A nice example is the project Laat je niet flessen (saying in Dutch, hard to translate in English, something like Don t be bottled )). This is a joint approach of 21 municipalities in the Netherlands. In cooperation with local organizations common goals are formulated as 1) delaying the start of alcohol consumption and 2) the decrease of inebriation in the public domain. Since multiple policies and activities are organized by different actors to reach these goals it is hard to distinguish independent interventions that can be described and replicated in other countries, as was the goal of this inventory. Nonetheless, one of the experts emphasizes the importance of integral local approaches and states that independent interventions can only be effective if they are supported by integral, connected policy.. 2

15 2. Description of two models of good practices in the Netherlands Based on the inventory in chapter one we choose two good practices for the Netherlands; one on the school and one on the family level. As we stated in the introduction, these domains are important allies in the fight against alcohol abuse among adolescents in the Netherlands. The first example is PAS. Of the three school based interventions this one has been accredited with the highest level of effectiveness. The second example is Triple P. We choose this intervention and not Homeparty, since it is applicable to a larger group of parents and therefore probably more interesting for other countries to learn from. Triple P is also set out in other European countries. Example 1: Name: Preventie Alcoholgebruik Scholieren (PAS) Goals: The goal of this intervention is to delay alcohol consumption among juveniles. Subgoals are: 1) to increase the number of parents who will not let their children drink alcohol, 2) to foster a negative attitude towards alcohol and increase self-control among juveniles. Theoretical framework: Recently, the importance of targeting not only children, but also their parents has been established clearly. Parents play a pivotal role when it comes to providing access to alcohol for early adolescents. Further, when parents set restrictive rules about alcohol use, their offspring are more likely to postpone drinking. Thus, to discourage alcohol use in early adolescents, it is imperative to consider both adolescents and their parents in interventions. Domain (individual, family, school, neighbourhood): school Age targeted: juveniles of years old and their parents Method: The intervention consists of one intervention aimed at parents and one aimed at students. Through a short presentation (20 minutes) at school, parents are taught about the risks of early alcohol consumption and motivated to adopt rules with other parents. After the meeting, all parent receive a leaflet with more information. The presentations are adjusted each year according to the age of the children, and parents can modify or add to the rules they made the year before. Through digital lessons, self-control and a healthy attitude towards alcohol consumption are developed with the juveniles. During the lessons, student can, individually and together with other students, work on assignments and watch short movies. Period: three years. One presentation for parents of the 7 th - 9 th grade students on the first parents night (ouderavond). Four digital lessons for students in the 7 th grade and a repetition in the 8 th grade. Literature: Koning, Vollebergh, Smit, Verdurmen, van den Eijnden, ter Bogt, et al. (2009). Preventing heavy alcohol use in adolescents (PAS): cluster randomized trial of a parent and student intervention offered separately and simultaneously, Addiction, 104, p Manuals or website: There are manuals available and a Power-Point presentation and brochures for parents. 3

16 Evaluation: Yes, both the juvenile intervention and the parent intervention are evaluated. If yes, efficacy according to formulated goals and effectiveness: The juvenile intervention is based on the alcohol lessons of the Healthy School and stimulants (de Gezonde School en Genotmiddelen). This intervention has proved to be effective. The parent intervention is based on a Swedish program for parents. In Sweden, the intervention turned out to be effective in decreasing the frequency of drunkenness. The analyses show that PAS can delay the start of weekly (heavy) drinking by 34 months if both juveniles and parents are involved in the interventions described. Only the combination of both interventions has proved to be effective. On the basis of this analysis, the judgment of the recognition committee is probably effective Example 2: Name: Triple P; Positive Parenting Program Goals: to prevent behavioural, emotional and developmental problems (under which alcohol consumption) in children by enhancing the knowledge, skills and confidence of parents. Theoretical framework: Different studies showed that bad parenting, conflicts in the family and divorces greatly influence the development of children. Especially the lack of a warm and positive relationship, inconsistent rules, inadequate supervision and inadequate involvement, marriage problems, divorces and parent with psychological problems are risk factors for emotional and behavioural problems, like alcohol abuses, drug use, antisocial behaviour and juvenile crime. Source: Sanders, M.R., Dadds, C.M. & Turner, K.M.T. (2003). Theoretical, scientific and clinical foundations of the Triple P- Positive Parenting Program: A population approach to the promotion of parenting competence. Parenting research and practice monograph, 1, Domain (individual, family, school, neighbourhood): Family Age targeted: 0-16 years old Method: Triple P incorporates five levels of intervention of increasing strength for parents of children from birth to age 16: 1. Providing parents with access to information about parenting through a coordinated media and promotional campaign using print and electronic media. This level of intervention aims to increase community awareness of parenting resources, to encourage parents to participate in programs, and to create a sense of optimism by depicting solutions to common behavioural and developmental concerns. 2. Brief, individual or seminar-based consultation with parents and caregivers. Level 2 interventions provide topic specific guidance to parents of children with mild behaviour difficulties, with the aid of user-friendly parenting tip sheets and videotapes that demonstrate specific parenting strategies. 3. A 4-session intervention targeting children with mild to moderate behaviour difficulties and includes active skills training for parents. 4. Level 4 interventions are more intensive than lower level interventions. You can run a level 4 intervention with individual parents, groups of parents or simply by guiding parents who are working from a Triple P self-help parenting 4

17 book. Level 4 interventions take between 8 to 10-sessions and are for parents of children with more severe behaviour difficulties. 5. Often practitioners work with parents and caregivers experiencing relationship conflict, parental depression or high levels of stress. These parents often benefit from a more intensive family intervention program. Level 5 is usually delivered to parents after they have undertaken a Level 4 intervention in an individual consultation format. Period: Developed more than 30 years ago. In the Netherlands since 2004 Literature: Blokland, G. (2007). Positief Opvoeden voor alle ouders. Utrecht: NJi. Graaf, I. de, Speetjens, P.A.M., Wollf, M.S. de, & Smit, H.F.E. (2008). Effectiveness of the Positive Parenting Program Triple P on behavioural problems in children: meta-analysis of randomized trials. Behaviour Modifi cation, 32, Graaf, I. de, Speetjens, P.A.M., Wollf, M.S. de, & Smit, H.F.E. (2008). Effectiveness of the Positive Parenting Program Triple P on parenting: a meta-analysis of randomized trials. Family Relations, 57(5), Nowak, C. & Heinrichs, N. (2008). A Comprehensive Meta-Analysis of Triple P-Positive Parenting Program Using Hierarchical Linear Modeling: Effectiveness and Moderating Variables. Clinical Child and Family Psychology Review, 11(3), Sanders, M. R. (1999). Triple P - Positive Parenting Program: towards an empirically validated multilevel parenting and family support strategy for the prevention of behaviour problems in children. Clinical Child and Family Psychology Review, 2, Manuals or website: Evaluation: Yes If yes, efficacy according to formulated goals and effectiveness: Parents report a decline in behaviour problems (under which alcohol consumption) and improvement of their raising skills directly after Triple P, 6 months later and 12 months later. 5

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