Interventions : Targeting Substance Abuse and Poverty Levels in Kent County, Michigan

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

2. Introduction In developing interventions for Kent County’s rise in substance abuse and poverty, we chose to target adolescents, focusing on prevention as our main intervention.

3. Best Practices Primary 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).

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

5. Best Practices Secondary 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)

6. Best Practices: Prevention Since our target group is adolescents living in Kent Countyatrisk for substance abuse who may be living in poverty, our interventions for substance abuse preventionamong this population will follow best practices with a focus on both primary and secondary community prevention.

7. Primary Prevention: Development of a Community Plan (NIDA, n.d.)

8. Primary Prevention cont’d (NIDA, n.d.)

9. Primary Prevention Works! One study measured communities which implemented a preventive strategy/interventiongroup 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:

10. Better Outcomes: • Community intervention group: 16.4% used alcohol in the past 30 days, compared to 21.4% among non-intervention control group • Community 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 group • Community intervention group: 2.2% used smokeless tobacco in the past 30 days, compared to 4.3% in the non-intervention control group (Reynolds, 2010)

11. 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

12. “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).

13. “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)

14. 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.

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

16. Suggested Universal Programs • Caring School Community Program • Classroom Centered and Family-School Partnership Intervention • Guiding Good Choices • Life Skills Training Program • Lions-Quest Skills for Adolescence, Project ALERT • Project STAR • Promoting Alternative Thinking Strategies (PATHS) • Skills Opportunity and Recognition (SOAR) • The Strengthening Families Program: For Parents and Youth 10-14.

17. Information on the above programs can be found at : http://drugabuse.gov/Prevention/examples.html

18. 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.

19. 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)

20. It’s All About Community As 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.

21. 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)

22. Classrooms Before Jail Cells The 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)

24. “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)

25. 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)

26. It’s All About Community • Efforts 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).

27. Community: Working Together • Increasing awareness of available programs • Key leaders in the community can help educate • Communities and schools need to develop partnerships in prevention programs

28. Potential EBP: Implementing evidence based substance abuse prevention programs in Kent county schools.

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

30. Evidence Based Practice “Drug 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).

31. Evidence Based Practice According 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).

32. Project: ALERT “One 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).

33. Project: ALERT Project ALERT : • Emphasizes- most of their peers do not use or approve of using drugs • Explains- 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).

34. Example 1of Project: ALERT Poster

35. Example 2 of Project: Alert Poster

36. Let’s Implement! To Implement: • Schools must allow a group to come into the school to teach the program • Schools 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

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

38. 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.

39. Community Goals Favorable 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).

40. Short Term Goals: • Adolescent’s discussing their belief regarding substance abuse • It is important to involve the patients in their own care (Harkness, 2011). • Assists in developing targeted education • Their intentions to use or refuse alcohol or drugs • Increased reported awareness of consequences of substance abuse • Increased coping skills to handle temptation and peer pressure • Achieved through educational and behavioral programs • Reflected in decreased rates of substance abuse • Evaluation of random drug testing

41. Long Term Goals: • Adolescents are sober and making healthier choices • Adolescents are attending group or individual therapy • Statistics at 1, 5, 10 and 15 years show reduction in substance abuse in adolescents in Kent County • Ideally, lowering adolescent substance abuse rates will eventually lead to lower adult rates of substance abuse

42. Primary Intervention Evaluation: If adolescents are engaged in regular physical activity, they are more than likely not abusing substances.

43. 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

44. 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).

45. 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 rates • Annual update of education programs to reflect current knowledge and practice • Feedback from participants

46. Determine effectiveness of universal substance abuse educational programs • “Another 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.

47. Determine effectiveness of universal substance abuse educational programs • Ensure that schools have adequate funding and resources to continue educational programs and ensure longevity • Effectiveness must be established and documented using participation rates and substance abuse rates as reported by the County

48. Secondary 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).

49. Secondary Intervention Evaluation • Choose 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

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