Drug education approaches in primary schools

Transcription

1 Prevention Research Evaluation Report Number 4 November 2002 Drug education approaches in primary schools by Ms Celia Godfrey, Associate Professor John W. Toumbourou, Mr Bosco Rowland, Dr Sheryl Hemphill and Mr Geoff Munro. Editorial Assistant: Ms Colleen Farrell Introduction Drug education is an important component in prevention efforts. The third report in this series examined drug education in secondary schools. In this fourth report we examine some approaches to primary school drug education, focusing on the available evidence for the effectiveness of this approach. Part 1 comprises a technical review of the evidence for the effectiveness of drug education and in Part 2 we report on a survey of practitioners views regarding current practice in drug education in Victorian schools. For the purposes of this discussion, drug education refers to efforts to reduce drug-related harm through the delivery of a structured socialhealth education curriculum in the primary school context, usually by classroom teachers, but in some cases by visiting professionals. Although in this series of reports we have presented programs targetting the primary and secondary school years separately, it is important to note that many programs in Australia actually bridge the transition from primary to secondary school. Furthermore, several programs that were initially developed for older or younger age groups have since been adapted for wider implementation throughout schools. In other cases, programs were initially developed to target specifically those families with drug-use problems, and have since been adapted to target a broader section of the population. PART 1 REVIEW OF THE LITERATURE Lloyd and colleagues (2000) conducted a review of the effectiveness of primary school drug education targetted to children younger than age 11 which have the objective of preventing illicit drug use (Lloyd et al. 2000). Their review concluded that knowledge about drugs and their effects is only one component of drug education, and that other elements were also important. These included the development of language and skills to identify feelings and communicate these to others. Their recommendations for future program development included the following: Drug education should start in primary school. Approaches based on life skills seem to be most effective. Projects should seek to involve parents and communities, where possible. Peer approaches show some promise. It is important that drug education continues into secondary school. Targetted approaches can be problematic. Long-term, intensive programs are more likely to be effective. Evaluation Although many drug-education programs exist, evaluation of these programs often has not occurred at all, or has tended to focus on process and intermediate factors rather than

2 outcomes for students. One reason for this lack of evaluation data is the length of time required for follow-up when a project delivered to 10-year-old children is unlikely to have a measurable effect on, for example, cannabis use, for around 4 to 5 years. This is a complication specific to interventions targetting younger children in contrast to the adolescent age group, where intervention effects often can be seen more quickly. This, in turn, creates problems for program developers when policy makers and program funders are rarely prepared to wait as long for results (Lloyd et al. 2000). Nevertheless, research in this area is continuing, and several programs have been evaluated comprehensively. What should be the content of drug education in primary school? The successful Illawarra Drug Education Program (IDEP) in New South Wales (Wragg 1990, 1992) targetted those drugs considered to be developmentally appropriate, with alcohol and tobacco, in particular, seen as gateway drugs. IDEP was designed to reduce uptake and assist students in decision making and resisting peer pressure in relation to drug use. The program was conducted over several weeks with Grade 6 students and included group work where students designed art works and short dramatic sketches that demonstrated ways of coping with peer or media pressure to use drugs. Parents were invited to attend three drug education nights during this time, and during the final session students presented the short plays they had worked on in class. In addition to this first phase of the program, a booster session occurred in Grade 7, when students showed videos of their plays and discussed the program with other students, and then returned to their primary schools to induct new Grade 6 students into the program. Students who received the intervention reported greater ability to resist peer pressure than control subjects and were more able to use drugs at a responsible and minimal level if they did engage in drug use. Despite positive program effects, Grade 9 appeared to be a critical time, when there was increase in experimentation with drugs. The authors argued that this provided a strong case for booster sessions into the early years of secondary school. The authors concluded that life-skills approaches presented to primary school children could have an impact on future smoking, alcohol consumption and use of illegal drugs. A British study, Project Charlie, adopted a broad-based life-skills approach to preventing drug use (Hurry & Lloyd, 1997). The program s content focused on peer selection, decision making, problem-solving, self-esteem enhancement and providing information related to drug use. Although the evaluation sample sizes were small, results showed that students who received the intervention were significantly less likely to have used tobacco and illicit drugs than controls at 4-year follow-up. Perry and colleagues evaluated the impact of the Slick Tracy Home Team program, a set of activity books completed as homework tasks requiring parental assistance over the course of 4 consecutive weeks in Grade 6, when students were approximately 11 years old (Perry et al. 1993). The authors noted that the strategy of seeding their program into school homework was successful in obtaining high rates of parental participation from a range of cultural backgrounds. At the end of Grade 6, families exposed to the intervention demonstrated increased communication regarding alcohol use, and children demonstrated lower initiation to smoking and regular alcohol use. How important is family and community involvement? A number of the primary school drug-education programs that have evidence for effectiveness have made very deliberate attempts to involve parents (for example, Wragg 1992). Strategies to involve parents have included parent education nights, with students presenting short plays, and homework to promote family discussion. Page 2 of 9

3 Programs encouraging family involvement in drug education can take several forms. A parent education program delivered in late primary school that has evidence for effectiveness in reducing subsequent drug use is the Preparing for the Drug Free Years (PDFY; Spoth et al. 1996;Spoth, Redmond & Shin 1998). Primary school-age, group family intervention programs with evidence for effectiveness include The Families and Schools Together (FAST) program (McDonald, Coe-Braddish & Billingham 1991) and the Iowa Strengthening Family Program (ISFP; Spoth et al. 1996;Spoth, Redmond & Shin 1998). Forthcoming reports in this series will review the literature relevant to primary school family interventions and parent education approaches. In what follows we focus on the involvement of parents within drug education curriculum, providing a brief overview of programs that have included components for families and parents. It is important to recognise that efforts to involve parents in drug education must be based on a realistic understanding of the parents beliefs and behaviours regarding drug use. In some communities with high rates of drug use, curriculum may be required to challenge some attitudes and behaviours accepted by parents. Involving parents in the planning and development of curriculum may be one method of encouraging a better fit to community values. Students in rural New Hampshire aged 9 to 14 years received either a drug prevention curriculum or this curriculum with additional parent and other community activities (Stevens et al. 1996). The authors reported that neither program had been successful in reducing students initiation to marijuana use when compared with controls, but there had been an impact on levels of regular marijuana use. It was argued that strategies to prevent marijuana use should consider the profile of the marijuana-using child, the adult community s attitudes and beliefs about drugs, and the access of drug sellers and users to children. The authors concluded that drug education curriculum alone cannot be expected to prepare children for parents and other adults beliefs and behaviours regarding drugs in their community. In order to have an effect on regular use of marijuana, parents and the community in which the children live need to be included in prevention strategies. Two well-evaluated projects have demontrated potential for conducting school drug education within the context of broader community mobilisation activities. Pentz and colleagues (Johnson et al. 1990) examined the effects of a school drug education program run in the context of the Midwest Prevention Program,a comprehensive community mobilisation program. A 10-session healtheducation program, focusing on drug use resistance skills, was delivered to Grade 6 and 7 students. Evaluation suggested positive program impacts on mediating factors (attiudes, knowledge, skills and peer influence) and on initiation and escalation in use of tobacco, alcohol and marijuana use after the first year. A three-year follow-up (Johnson et al. 1990) combined the drug education program with a parent organisation program for reviewin school prevention policy and training parents in positive parent child communication skills in the context of community mobilisation elements. The program appeared to be effec-ive in preventing escalation in tobacco and marijuana use, but not alcohol use. Effects were most prominent when delivered in Grade 7. Research reported by Perry and colleagues provides further insight into the effectiveness of health education delivered within the context of wider community mobilisation efforts. It would appear from the Project Northland research (Klepp, Perry & Kelder 1995) that the common observation that educational impacts decay over time also applies to interventions run in the context of wider community mobilisation. A cohort exposed to a socialinfluence, health-education curriculum from Grade 6 through to Grade 9 demonstrated lower rates of recent alcohol use and alcohol misuse. These effects tended to decline in the years following the intervention, such that there were few significant effects by Grade 12. Page 3 of 9

4 What is the best age to educate young people about drug use? In considering the role of primary school drug education it is important to consider the developmental issues of children through this period and their relevance to the subsequent emergence of drug use. Risk factors in late primary school that might influence subsequent involvement in harmful drug use include bonding and commitment to school, peer relationships and family attachment. It is possible that program elements that address these risk factors might be more important in primary school than curriculum specifically addressing drug use. Having made this statement, it is important to observe that by the first year of high school in 1999, rates of recent drug use were 9 per cent for tobacco and 27 per cent for alcohol (Bond et al. 2000). The finding of high rates of licit drug use in early high school has led to arguments for specific drug prevention activities to be initiated in younger age groups (Lloyd et al. 2000). In attempting to design effective drug education programs in primary school it is important to note that many evaluations have demonstrated difficulties in achieving behavioural change. Although there have been a number of evaluation studies, it is not yet clear as to which program elements differentiate effective from less effective programs. A number of the evaluations suggest that curriculum that is focused very narrowly on drug use may need careful monitoring. For example, Ringwalt and colleagues found no effect for a program delivered in Grades 5 and 6 (Ringwalt, Ennett & Holt 1991) and Johnson and colleagues (Johnson et al. 1990) found their program was more effective when delivered in Grade 7 rather than Grade 6. In developing primary school programs, it is important to keep an eye to the future. In their evaluation of the IDEP, Wragg and colleagues noted the need for primary school curriculum to be integrated with booster sessions at critical developmental points when drug use was likely to increase, such as Grade 9 in high school (Wragg 1992). In the IDEP program elements included a range of broader topics including decision making, managing life problems and stress, and committing to live a healthy lifestyle. Should we target primary school drug education to specific at-risk children? Those with experience working in primary schools are often aware of children who appear to be at-risk of drug use due to school and family difficulties. An example of children in this category may be children in families in which parents are experiencing drug-use problems. The question is immediately raised as to whether drug education might be beneficially directed or targeted to this group. Available evidence is limited but suggests that there may be some benefits in running specific programs for high-risk children. The program by DeWitt and colleagues assessed an in-school program (Opening Doors) aimed at preventing or reducing drug use and other deviant behaviour in high-risk young people during their transition from primary to secondary school (DeWitt et al. 2000). This program was reviewed in our previous report, which addressed drug education approaches in secondary schools. In brief, the program selected high-risk students using a screening test assessing demographic and behavioural variables. Participants demonstrated a range of behavioural improvements relative to those in a control group at a 6-month follow-up. There are dangers associated with targetting programs to at-risk children. These include the potential for such programs to result in children being labelled as problematic, and the risk of increasing problems where young people s attitudes and behaviours favourable to drug use are promoted. The existence of these dangers suggests that targetted programs should be approached with caution and accompanied with evaluation and monitoring. Available evidence suggests that a safer program strategy may involve delivering Page 4 of 9

5 a broad curriculum of drug education across the spectrum of children within primary school. Conclusion Although drug education approaches are being implemented in primary schools, further research will be required to establish the effectiveness of this strategy. At this stage it appears that approaches which are interactive, intensive, based on life skills, and which focus on parents and communities as well as schools, tend to be most successful (Lloyd et al. 2000). PART 2 CURRENT PRACTICE IN PRIMARY SCHOOL DRUG EDUCATION As a complement to the literature review of formal classroom-based drug education, staff at the Centre for Youth Drug Studies (CYDS) at the Australian Drug Foundation interviewed nine key informants, namely teachers, consultants and policy developers, in order to identify differing perspectives on the current state of practice in Victoria. An interview schedule of seven main questions was drawn up for each respondent, with each question having a number of sub-questions that were modified as appropriate to the practitioner being interviewed. Defining the content of primary school drug education Those interviewed in primary schools supported a definition of drug education that was congruent with best practice emerging from the literature. Interviewees unanimously suggested that the term drug education is more than just the naming and providing of information about specific drugs. Interviewees generally considered drug education as falling under the broader umbrella of health and wellbeing, with its purpose being to provide students with skills and a healthy attitude to life. One educator described it as giving children a skills repertoire that will help them operate as a member of society, while a consultant described it as giving students an awareness of what goes towards a healthier life and how we look after our bodies. Thus, interviewees reported that drug education programs cover a spectrum of topics. Among the most commonly cited were the teaching of personal and social skills, and helping students to understand and maintain relationships. Issues around resilience, well-being, hygiene, nutrition, bullying, conflict resolution and emotional intelligence were also reported to be essential parts of a primary schools drug education program. When, and why, should primary schools carry out drug education? It was generally agreed that primary school drug education was best placed to begin in Prep. Grade. However, a researcher indicated that the evidence suggests that primary school drug education should begin when risk-taking behaviours commence at the very latter end of primary school or early secondary school (researcher), and an educator suggested that it should begin at home and ideally should begin the moment they re [the students are] born, [through] the influence their families have on them. Nevertheless, the majority of interviewees stated that it was vital that primary schools provide drug education, the principal reason being that it was the role of educators to prepare people for the journey through life (consultant). Other reasons were that schools are the one institution left that actually has the capacity to make a difference in kids lives, where community and society is failing them (state coordinator); that schools can possibly provide alternate messages and practices to those practised at home (consultant); and that it helps young people in a safe and supportive environment to test out repertoires, to think about issues in a way they may not get in a home, church or other place (educator). Page 5 of 9

6 Should primary school drug education specifically mention drugs? Interviewees agreed that specific terms and information about licit and illicit drugs were best left for the later primary school years, and saw the early years of primary school as a period when the safe handling of medication could be discussed and when students could be encouraged to think about alternative behaviours. For example, one educator suggested a typical exercise could be asking children to think about alternative ways to deal with a headache, other than taking medication. Alternative responses could be going for a walk, having a glass of water or lying down for a rest. It was pointed out by an academic, however, that when delivering drug education it is always important to factor in children s developmental stages and their capacity for learning and knowledge. Legal drugs such as tobacco, alcohol and caffeine were said to be best introduced in the middle primary years, and some interviewees suggested that illicit drugs such as cannabis be introduced in the last couple of years of primary school, given that it is so readily available and so much a drug of choice as they get into secondary school (consultant). However, a number of interviewees indicated that in primary schools illicit drugs should be dealt with on a needs basis. That is, illicit drugs were only discussed if they were raised specifically by a student or if they were featured in the media (educator). Despite a number of interviewees suggesting specific years for the introduction of particular drugs, one state coordinator suggested that it is possible to deliver a Kindergarten to Grade 6 curriculum of health and physical education and not even to mention the term drug. She went on to say that the fundamental focus of primary school drug education is to embed them in much broader questions about how do I make healthy decisions about life and how do I make decisions about my health. All interviewees considered welfare to be an essential part of a school s broader drug education program. Can primary school drug education effectively alter behaviour? Interviewees opinions were mixed on how effective primary school drug education could be at promoting factors that ultimately result in behavioural change. One educator suggested that it was too complex to gauge because drug education was multifaceted, while another consultant stated that it was too complex to gauge because the schools drug education was so diverse. In contrast, primary school drug education was perceived to be effective because of positive feedback received from teachers and because students presented with a fairly sophisticated knowledge of drugs and what are harmful situations (consultant). Another interviewee stated that her program was effective because the school s drug education program had been designed around issues students raised with the school counsellor. As the number of visits to the counsellor had diminished since the inception of the program, she judged the program to be effective. Despite mixed opinions between interviewees, a number of possible ways to measure effectiveness were suggested. One suggestion was that it could be gauged by assessing whether children s needs were being met and whether they were getting answers to their questions. One way of achieving this was to have students evaluate drug education units. A state drug education coordinator was highly supportive of the Erabus consulting tool, which measures a variety of aspects of school functioning, including school ethos, the curriculum, the teaching learning practices, the organisational structures, and the relationships from the top down. A number of interviewees suggested that in many ways effective drug education is only as good as the teacher who is delivering it, and to this end poor teachers were a barrier to effective drug education. Teachers who were possible barriers to effective drug education were described as having a narrow view of Page 6 of 9

7 drug education (consultant); not seeing the relevance (educator); teachers feeling illprepared or ill-informed about the nature and content of drug education. Other barriers were perceived to be systemic, and these included lack of support from the principal and administration, lack of time, crowded curriculum, and resources that were not user-friendly. To what extent is the transition from primary school to secondary school drug education achieved? Poorly accomplished was how a number of interviewees described the transition from primary to secondary school drug education in government schools. The government sector was viewed this way largely due to poor communication between primary and secondary schools. However, this was partly because, in any given government primary school, students could go out to 20 secondary schools (educator). A Catholic Schools Education Officer stated that, in terms of broader student welfare, he perceived the transition as effective. An independent school (Kindergarten to Year 12) interviewee described her school as achieving the transition because a health committee comprising representatives from Prep to Year 12 were the steering committee for the drug education program in the school. In order to promote an effective transition from primary to secondary school drug education, a variety of models were reported to be employed in all sectors. The Catholic sector uses the School Transition and Resilience Training (START) program. The START program aims to build resilience in Year 6 children while also working with Year 7 teachers to help build continuity between primary and secondary programs. Government school interviewees reported employing both collegial support groups to promote communication with teachers between primary and secondary schools, and implementing the Department of Education s Student Support Services Framework. An independent school (Kindergarten to Year 12) interviewee reported implementing the take Time to Think and Talk (TTT) program. TTT was implemented in Year 6 and Year 7 over eight sessions during each year, in order to facilitate an effective overall transition from primary to secondary school drug education. How well does drug education encourage parental involvement? Most interviewees reported having parents involved in their primary school drug education programs, and two key themes were raised as to why it was important to involve parents. Firstly, parents were seen as having a place in every aspect of health and social development for kids (researcher). The second, and more dominant, theme was that drug education was perceived by interviewees as being undertaken as a partnership between the school and the home (educator). Involving parents not only took away the mystery of drug education for parents, it also attempted to promote consistency between the messages students were hearing in the home and messages they were hearing at school. It was also reported that having parents involved in drug education exposed parents to a variety of resources that they may not otherwise access. Parents were invited to participate in their children s education through a variety of ways; however, the level to which parents responded to these invitations was seen to be patchy or poor. Reasons cited were that parents had little time left in their working lives to attend school activities and that drug education was an area about which they were fearful. It should be noted, however, that a number of interviewees suggested that the response from parents increased when drug education was promoted under the broader umbrella of development and risk-taking behaviour (researcher) and advertised through word of mouth by key and active parents in the school community. Programs employed by schools to involve parents included Talking Tactics Together, Creating Conversations, and take Time to Think and Talk. Page 7 of 9

8 Alignment with the Individual Schools Drug Education Strategy Global and specific comments were made about the alignment of classroom practice with the classroom-based component of the ISDES. Global comments emphasised classroom practice as being moderately aligned because of the expectation that there would always be some schools which would not implement what they had documented in their ISDES. Specific comments focused on interviewees experiences, and emphasised the strong alignment of practice and the classroom component of the ISDES within a particular setting. All interviewees indicated that having schools undertake the ISDES process helped to put drug education on the agenda. Two consultants, however, pointed out that schools needed to focus now on how they could sustain consistent drug education in schools. Conclusions The evidence supporting the effectiveness of primary school drug education is thin relative to the literature focusing on secondary school. In general, the comments from interviewees point to a considerable understanding of the need for caution in approaching education relevant to specific drug behaviour, and the need to incorporate a broad life skills approach which includes parents. The problem of integrating primary school activities with subsequent drug education emerges as an important issue. In closing comments some interviewees argued the need to consider how drug education could be integrated across the journey from primary school through to tertiary education. A suggestion by one researcher was to develop programs in primary schools that looked at risk-taking behaviour in secondary schools. One State coordinator suggested that documents like the Australian Nation Council on Drugs paper on Structural Determinants of Drug Use have blown the old systems out of the water and helped to demonstrate that traditional methods have not changed behaviour, while also supporting the notion that drug education needs to be holistic. This report was prepared for the DrugInfo Clearinghouse by the Centre for Adolescent Health and the Centre for Youth Drug Studies, Melbourne Page 8 of 9

9 References Bond L, Thomas L, Toumbourou JW, Patton G & Catalano R 2000, Improving the lives of young Victorians in our community: A survey of risk and protective factors, Parkville: Centre for Adolescent Health, Royal Children's Hospital DeWitt DJ, Steep B, Silverman G, Stevens- Lavigne A, Ellis K, Smythe C, Rye BJ, Braun K & Wood E 2000 Evaluating an in-school drug prevention program for at-risk youth, The Alberta Journal of Education Research, XLVI:2, Hurry J & Lloyd C 1997 A follow-up evaluation of Project Charlie: A lifeskills drug education programme of primary schools, London: Home Office, 16 Johnson CA, Pentz MA, Weber MD, Dwyer JH, Baer N, MacKinnon DP & Hansen WB 1990 Relative effectiveness of comprehensive community programming for drug abuse prevention with high-risk and how-risk adolescents, Journal of Consulting and Clinical Psychology, 58:4, Klepp KI, Perry C & Kelder S 1995 Alcohol and marijuana use among adolescents: Long-term outcomes of the Class of 1989 Study, Annals of Behavioural Medicine, 17:1, Lloyd C, Joyce R, Hurry J & Ashton M 2000 The effectiveness of primary school drug education, Drugs: Education, prevention and policy, 7: 2, McDonald L, Coe-Braddish D & Billingham S 1991 Families and schools together: An innovative substance abuse prevention program, Social Work and Education, 13, Perry CL, Williams CL, Forster JL, Wolfson M, Wagenaar AC, Finnega JR, McGovern PG, Veblen-Mortensen S, Komro KA & Anstine PS 1993 Background, conceptualization and design of a community-wide research program on adolescent alcohol use: Project Northland, Health Education Research: Theory and Practice, 8, Ringwalt C, Ennett ST & Holt KD 1991 An outcome evaluation of Project DARE (Drug Abuse Resistance Education), Health Education Research, 6:3, Spoth R, Redmond C, Hockaday C & Yoo S 1996 Protective factors and young adolescent tendency to abstain from alcohol use: A model using two waves of intervention study data, American Journal of Community Psychology, 24, Spoth R, Redmond C & Shin C 1998 Direct and indirect latent-variable parenting outcomes of two universal family-focussed preventive interventions: Extending a public healthoriented research bbase, Journal of Consulting & Clinical Psychology, 66,2, Stevens MM, Freeman DH, Mott L & Youells F 1996 Three-year results of prevention programs on marijuana use: The New Hampshire Study, Journal of Drug Education, 26:3, Wragg J 1992 An evaluation of a model of drug education, Canberra: Commonwealth of Australia, 22 Wragg J 1990 The longitudinal evaluation of a primary school drug education pprogram: Did it work?, Drug Education Journal of Australia, 4:1, Page 9 of 9