Title

Interventions: Targeting Substance Abuse and Poverty Levels in Kent County, Michigan Darlene DArcangelo, Jennifer Paulsen, Ryan Peggar, Sarah Rooks, Shenna Throop, Deanna Warnock, and Angela Grubaugh

IntroductionIn developing interventions for Kent Countys rise in substance abuse and poverty, we chose to target adolescents, focusing on prevention as our main intervention.

2Best PracticesPrimary prevention in the community takes place by maximizing health and wellness through strategies that are set in place before illness is present (Harkness & Demarco, 2012, p. 65).

Best PracticesResearch has shown that substance abuse among adolescents, some of whom live in poverty, is lessened through primary and secondary community prevention efforts (NIDA, 2010).

4Best PracticesSecondary prevention in the community takes place by maximizing health and wellness through strategies that are set in place at the early and active chronic stages of pathogenesis of illness (Harkness & DeMarco, 2012, p. 65)

5Best Practices: PreventionSince our target group is adolescents living in Kent County at risk for substance abuse who may be living in poverty, our interventions for substance abuse prevention among this population will follow best practices with a focus on both primary and secondary community prevention.

Both Primary and secondary community prevention will be discussed as part of our prevention process6Primary Prevention: Development of a Community Plan

(NIDA, n.d.)

Narrated notes for this slide: development of a community plan includes identifying problem drugs in a community and assessing readiness for change in the community. Part of the action plan includes building on existing resources in place and determining which plans are working. Developing both short-term and long-term goals for the plan, and performing assessment and evaluation of outcomes may help in identifying which interventions are successful.

7Primary Prevention contd

(NIDA, n.d.)

Narrated notes: development of a community action plan to combat substance abuse among at-risk adolescents includes collaboration from parents, educators, and community leaders

8Primary Prevention Works!One study measured communities which implemented a preventive strategy/intervention group targeting adolescent substance abuse VS communities who did not implement such a preventive strategy/intervention group, it was found that the group which used community intervention plans had better outcomes:

Better Outcomes:Community intervention group: 16.4% used alcohol in the past 30 days, compared to 21.4% among non-intervention control groupCommunity intervention group: 5.7% had five or more drinks in a row in the past two weeks, compared to 9% in the non-intervention control groupCommunity intervention group: 2.2% used smokeless tobacco in the past 30 days, compared to 4.3% in the non-intervention control group(Reynolds, 2010)

Primary Interventions that Work!

Primary Intervention: Increase physical activity amongst adolescents, through required participation in physical education activities in schools, as well as encouraging opportunities to participate in extracurricular sports

Patterns of drug abuse among teens suggest that physical activity can strengthen resistance to addiction... high school students who exercise regularly are less likely than sedentary teens to smoke cigarettes or abuse marijuana (Volkow, 2010). As part of their community/school program to counter substance abuse, the community should provide regular activities that are supportive alternatives to the abuse of drugs (Pediatrics, 2007)

Primary Interventions That Work!Primary Intervention: Initiation of universal substance abuse and prevention programs for adolescents in schools. This targets all adolescents in both the private and public sector, which by default enables education for at-risk groups of adolescents living in poverty.

Universal Programs:Universal programs target all children in schools.This encompasses children who may be more at risk for substance abuse due to poverty.

Suggested Universal Programs Caring School Community ProgramClassroom Centered and Family-School Partnership InterventionGuiding Good Choices Life Skills Training ProgramLions-Quest Skills for Adolescence, Project ALERTProject STARPromoting Alternative Thinking Strategies (PATHS)Skills Opportunity and Recognition (SOAR)The Strengthening Families Program: For Parents and Youth 10-14.

Information on the above programs can be found at :

http://drugabuse.gov/Prevention/examples.html

Secondary Interventions That Work! Secondary Intervention: Implement programs that reward abstinence from substance abuse in adolescents who have previously abused substances by offering incentives, rewards, or prizes for substance abuse abstinence.

This technique involves a shift in perspective from punishing lapses in sobriety to celebrating successes by rewarding teens who are abstinent from substances with the opportunity to win prizes or vouchers for positive behaviors (Whitten, 2006)

Its All About CommunityAs a community trying to prevent substance abuse it is of the utmost importance that we educate adolescents regarding substance abuse before it becomes problematic which may lead to lifetime addictions or legal complications.

Classrooms Before Jail Cells Some groups, such as juvenile offenders are more likely to become substance abusers. OJP Issues. (U.S. Department of Justice, 2000)

Classrooms Before Jail CellsThe educational system is routinely used to bring awareness of substance abuse and prevention.

It is important that we reach adolescents in this venue rather than in the youth criminal justice system. (TEDS Report, 2009)

Elementary, middle, and high schools have become important arenas for educational programs in the field of substance abuse prevention, but these institutions also can serve a significant role in the early identification of students in need of professional substance abuse treatment ( TEDS REPORT, 2009)

Programs That Work! Over one half (52 percent) of children and adolescents referred to substance abuse treatment through the educational system completed treatment.(Teds Report, 2009)

Its All About CommunityEfforts need to be community-wide to make a lasting impact on it residents.Research shows, that even when school programs change behavior, this success is short-lived in the absence of community norms that support the program goals (Bogenschneider 1996:133).

Community: Working TogetherIncreasing awareness of available programs Key leaders in the community can help educateCommunities and schools need to develop partnerships in prevention programsPotential EBP: Implementing evidence based substance abuse prevention programs in Kent county schools.

Evidence Based PracticeDrug prevention programs in schools are a critical element of the antidrug effort (Ellickson, McCaffrey, Ghosh-Dastidar & Lonshore, 2003, p. 1830).

Narration: Evidence based prevention programs in schools have the greatest impact on adolescents who are no- drug users (Brown, Guo, Singer, Downes & Brinales, 2007, p. 34) Reaching out to kids through school programs to prevent substance abuse before it starts is key.)

29Evidence Based PracticeDrug abuse typically begins during the adolescent years, prior to adulthood and school settings provide a prevention curriculum prior to the onset of use (Inman, Bakergem, LaRosa & Garr, 2011, p. 213).

(Narration: The school setting provides a prime opportunity to educate adolescents on drug prevention within the community. Teaching youth in school provides a way to offer education to a large group.)

30Evidence Based PracticeAccording to Johnson, Holder, Ogilvie, Collins, Courser, Miller, Moore & Saltz (2007):Substance abuse prevention programs in schools should increase cognitive-behavior skills while decreasing the motivation to use drugs, and decrease vulnerability of influence that promote drug use (p. 231).

(Narration: There are several programs that offer skills to adolescents to promote substance abuse preventions. Two of these types of programs are Life Skills Training (LST) and Project ALERT.)

31Project: ALERTOne of the most successful evidence based programs is Project ALERT, a drug prevention curriculum for middle school students that has been recognized as an exemplary program by the Department of Education and as a model program by the Center for Substance Abuse Prevention (Ellickson, et al, 2003, p. 1830).

(Naration: Project ALERT seeks to motivate students against using drugs and to give them the skills they need to translate that motivation into effective resistance behavior, an approach that is widely viewed as the state of the art in drug prevention Ellickson, et al, 2003, p. 1830).

32Project: ALERTProject ALERT :Emphasizes- most of their peers do not use or approve of using drugsExplains- the seriousness and consequences to drug use Builds- their skills on resisting drug use and avoiding situations where other peers are using drugs

This type of a program is a social influence based school program (Orlando, et al, 2005, p. 45).

Example 1of Project: ALERT Poster

Example 2 of Project: Alert Poster

Lets Implement!To Implement:Schools must allow a group to come into the school to teach the programSchools must give permission for this type of project Schools must review curriculum Schools must plan to ensure it is appropriate for the school setting Parents must give permission

Implementing and evidence based program into Kent county schools could prove to reduce the initiation of substance abuse in adolescents in the area.

Community Goals:The eventual desired outcome is to reduce and/or eliminate substance abuse among adolescents in Kent County, with the goal of total abstinence for every adolescent.

38Community GoalsFavorable treatment and educational outcomes can be judged by increased lengths of time a person is in abstinence, experiences decreased denial, improved family relationships, and ultimately the ability to relate normally and comfortably to other human beings (Varcarolis, Carson, Shoemaker 2006, p. 569).Short Term Goals:Adolescents discussing their belief regarding substance abuseIt is important to involve the patients in their own care (Harkness, 2011).Assists in developing targeted educationTheir intentions to use or refuse alcohol or drugsIncreased reported awareness of consequences of substance abuseIncreased coping skills to handle temptation and peer pressureAchieved through educational and behavioral programsReflected in decreased rates of substance abuseEvaluation of random drug testing

Long Term Goals:Adolescents are sober and making healthier choicesAdolescents are attending group or individual therapyStatistics at 1, 5, 10 and 15 years show reduction in substance abuse in adolescents in Kent CountyIdeally, lowering adolescent substance abuse rates will eventually lead to lower adult rates of substance abuse

Primary Intervention Evaluation:

If adolescents are engaged in regular physical activity, they are more than likely not abusing substances.

Primary Intervention Evaluations:Physical activity of adolescents can be measured with: self-reporting, journals, activity logs and questionnaires. These activities are valid indicators demonstrated by the frequency and consistency of exercise. We can also track outcomes with objective measures of physical activity such as direct observation, heart rate monitoring and pedometers (Trost, 2011).Schools encouraged to incorporate physical activity into their permanent curriculum, allowing for better monitoring of results

Primary Intervention Evaluation Continued:Evaluation would determine the percentage of adolescents involved in physical activity at six months, one year and two years to determine long term effectiveness of intervention.Substance abuse rates of adolescents in the exercise programs would be compared to those not in the program to determine whether exercise program is effective.Additionally, statistics would show if adolescents are physically active long term, thus indicating healthy habit formation (Taleshek et al, 1994).

Determine effectiveness of universal substance abuse educational programs

Evaluate and improve universal programs if necessary. Determine what percentage of at-risk youth is being reached by the program. Annual analysis of substance abuse ratesAnnual update of education programs to reflect current knowledge and practiceFeedback from participants

Determine effectiveness of universal substance abuse educational programsAnother evaluation approach is to track existing data over time on drug abuse among students in school, rates of truancy, school suspensions, drug-abuse arrests, and drug-related emergency room admissions (NIDA, 2003 p.17 ).Comparison of schools with education programs compared to similar schools that lack education programs.Tracking data allows for adjusting educational programs.

Determine effectiveness of universal substance abuse educational programsEnsure that schools have adequate funding and resources to continue educational programs and ensure longevityEffectiveness must be established and documented using participation rates and substance abuse rates as reported by the County

Narrated notes: It is important to evaluate school based intervention programs by addressing a few fundamental questions.How much exposure on the subject are the students receiving?Is there an assessment component and if so it is being used?Have teachers mastered the content and delivery of the subject matter? (NIDA, 2003)Is the education up to date and relevant?In regards to monitoring physical activity in the stated programs, one must consider the fact we are targeting adolescents. Realizing that adolescents are less likely to participate in journals or self-logs, direct supervision and school programs are essential to ensure adequate data accumulation.

47Secondary Intervention Evaluation

Contingency management works: Numerous studies have demonstrated its success in treating addiction when combined with other forms of behavioral counseling (Lowry, 2009 para.2).

Secondary Intervention EvaluationChoose realistic target goals to reward abstinence with a prize, gift voucher or other incentive. Evaluation of success of intervention can be determined by urinalysis testing or breathalyzers for alcohol testing as an indicator of substance use.Interview adolescents receiving rewards to garner perceptions

Secondary Intervention EvaluationSuccess of interventions can be determined with adolescent retention rates.Compare to adolescents not involved in secondary interventionsMonitor statistics over time, with goal being to reduce substance abuse rates

Narrated notes: Adolescent substance abuse statistics will show an increase or decrease in substance abuse over a period of time allowing us to monitor any changes in the epidemic. Self-reporting is not a valid indicator for determining adolescent substance abuse because most individuals will report lower levels of use or denial of usage. Feedback from adolescents in the programs are important to help determine effectiveness and usefulness of the interventions.

50Conclusion:By showing effectiveness of preventative intervention among adolescents, we show decrease levels of substance abuse and povertyBy planning goals for Kent County, these goals could be applied to the future of this community

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Trost, S. G. (2007, July). State of the Art Reviews: Measurement of physical activity in children and adolescents.American Journal of Lifestyle Medicine,1(4). doi: 10.1177/1559827607301686US Department of Justice. (September, 2000). OJP Issues & Practices Report. In Promising Strategies to Reduce Substance Abuse. Retrieved October 24, 2011, from https://www.ncjrs.gov/pdffiles1/ojp/183152.pdfVarcarolis, E. M., Benner Carson, V., & Shoemaker, N. (2006).Foundations of Psychiatric mental health nursing: A clinical approach(Fifth ed., pp. 568-569). St. Louis, MO: Saunders Elsevier.Volkow, N. (2010). Physical activity may prevent substance abuse. NIDA Notes, 23(4), 2.Whitten, L. (2006). Low-cost incentives improve outcomes in stimulant abuse treatment. NIDA Notes, 21(1), 1, 6-7.