High Quality Implementation:

Meeting the Challenge

Linda Dusenbury, Ph.D.Tanglewood Research

Key Elements ofEffective Programs

• Theoretically valid program content• Comprehensive approaches• Developmentally appropriate material• Sensitivity to the culture and community• Sufficient dosage and follow-up• Use of interactive teaching techniques• Well-trained implementers• Continuing evaluation

Content of Effective Programs

• Norm Setting• Social Resistance Skill Training• Competence Enhancement

Norm Setting

• Establishing positive norms• Correcting misperceptions about

behavior• Correcting misperceptions about

attitudes

Social Resistance Skills Training

• Recognizing influences• Developing cognitive techniques• Developing peer resistance skills

Competence Enhancement

• Personal Skills Decision Making Stress Management Goal Setting

• Social Skills Communication Skills General Social Skills Assertiveness Skills

Prevention Programs Also Promote Academic

AchievementAcademic achievement benefits from:• Social and personal skills• Positive norms• The reduction of multiple behaviors• Increased school bonding• Positive school climate• Involved families

Ineffective Prevention Strategies

• Scare tactics and moralistic appeals• Exclusive focus on Information• Exclusive focus on self-esteem• Testimonials by addicts• Congregation of high-risk youth

Effects of Fidelity on Smoking

0

5

10

15

20

25

30

Control Group Full ExperimentalGroup

High FidelityGroup

Per

cen

t S

mok

ing

Source: Botvin,G.J., Baker,E., Dusenbury,L., Botvin,E.M., Diaz,T. (1995). JAMA, 273, 1106-1112.

Effects of Fidelity on Alcohol

0

5

10

15

20

25

30

35

Control Group Full ExperimentalGroup

High FidelityGroup

Per

cen

t D

rin

kin

g A

lcoh

ol

Source: Botvin,G.J., Baker,E., Dusenbury,L., Botvin,E.M., Diaz,T. (1995). JAMA, 273, 1106-1112.

Effects of Fidelity on Marijuana

0

5

10

15

20

Control Group Full ExperimentalGroup

High FidelityGroup

Per

cen

t U

sin

g M

arij

uan

a

Source: Botvin,G.J., Baker,E., Dusenbury,L., Botvin,E.M., Diaz,T. (1995). JAMA, 273, 1106-1112.

Professional Groups Interviewed

• Researchers• Program Developers • School Administrators • Teachers • Safe and Drug-Free Schools Coordinators

Dusenbury, Brannigan, Falco, & Lake. (in press) An exploration of Fidelity of Implementationin Drug Abuse Prevention Among Five Professional Groups. Journal of Alcohol and Drug Education.

Source: Dusenbury, Brannigan, Falco, Hansen (2003) A review of research on fidelity of implementation: implications for drug abuse prevention in school settings Health Education Research. 18: 237-256.

Factors Influencing Quality of Implementation

• Program characteristics• Organizational characteristics• Characteristics of the provider• Match between program and

participants

Researchers’ Perceptions of Barriers to Effective

Implementation• Lack of Training• Lack of Support• Lack of Control• Competing Demands• Poor Match Between Program and

Participants

Researchers’ Strategies for Improving

Implementation• Identifying essential content• Detailed instruction manuals• Methodology for assessing fidelity• Communication• Staff development and training• Support

Program Developers’ Perceptions of Barriers to Effective Implementation

• Providers’ need to adapt programs• Limited time and competing demands• Program maintenance• Hostile culture and lack of support• Resistance by providers• Lack of resources

Program Developers’ Strategies for Improving

Implementation

• Detailed instruction manuals• Strong message: Don’t change the

material! • Staff development and training• Ongoing support and consultation

Other Considerations for Improving Implementation

• A program champion• Choosing the right providers• Flexibility

Administrators’ Strategies for Improving

Implementation• Staff development and training• Technical support• Measures to assess fidelity

Teachers’ Perceptions of Barriers to Effective

Implementation

• Certain teaching strategies or activities

• Student resistance • Limited time• Miscellaneous difficulties • Day-to-day crises

Teachers’ Strategies for Improving Implementation

• Creative adaptations• Specific adjustments• Infusing the program• Staff development and training

Safe and Drug-Free Schools Coordinators’ Strategies for Improving Implementation

• Networking• State coordination• Program assessments and guides• Staff development and training• Experience• Administrative leadership and support

Strategies to Increase Effectiveness

• High Quality Implementation– Follow the program as outlined– Make modifications that fit the theory– Staff development – Ongoing technical support

• Institutionalization– Continuity across grades– Continuity of staff– Program champions