School-based interventions to reduce drug/alcohol use Evidence-based practice in the trenches

1. School-based interventions to reduce drug/alcohol use Evidence-based practice in the trenches www.pv-psg.org 316-284-6446 regierng@pvi.org

2. Who is Prairie View? • Non-profit Community Mental Health Center • Open since 1954 • 450 employees, serves 12,000 patients/year • Full range of services, including inpatient hospital, outpatient therapy, school for at-risk youth, adolescent residential program, community-based outreach, housing • 15 years of clinical outcomes research • 14 years of adventure-based programming with inpatient, outpatient, and non-clinical populations of all ages • 6 years of outcomes research in adventure • Partnering with Project Adventure to study outcomes tools, provide open enrollment trainings, and study behavioral management models.

3. Who is Process Solutions? • Prairie View’s organizational consulting, training, and research division • Vision statement: Renewing Spirit, Discovering Strengths, Pursuing Excellence • Three core components • Process Communication Model (PCM) • Adventure-based learning models • Self-Efficacy outcomes measurement

4. Overview • Setting the stage • Getting the contract – making the case, connecting the dots • Research design and data collection • Results so far • Lessons learned • Discussion

5. Prior experience • Worked with Haysville Alternative school during 2005-2006 school years experimenting with combination of adventure course and school-based adventure groups. • Collected outcomes data with control groups showing effectiveness in raising self-efficacy • Had begun capacity building with alternative school staff to conduct school-based groups

6. The big one! • Haysville school district taking bids on drug-alcohol reduction programs • Already had a liking for adventure-based methods • Strong school board pressure for hard-line fear-based tactics such as drug dogs • School advisory council allowed us to make a presentation, submit a bid

7. Making our case • Escalating drug and alcohol use, along with the negative health and societal consequences • Increasing communication gap between youth and adult culture • Changes in socio-economic profile and gaps • Increasingly fragmented family and community support systems • More and more responsibility shifted to schools to help deal with the problems • So many things interfering with the learning process

8. Our hope • Reducing drug and alcohol use/abuse among youth • Making school a place where youth are developing the skills necessary to become healthy, contributing adults • Feeling like we are really connecting with kids, making a difference in their lives • Modeling effective approaches, where others can come to observe and learn

9. Where’s the problem? Where’s the solution? • Attitudes, values, and beliefs about student drug and alcohol use • From your perspective, what’s the solution to all this nonsense?

10. How did you answer? • Nurturing ___ • Values ___ • Information ___ • Fun ___ • Direction ___ • Excitement ___

11. Source: Pauley, Bradley & Pauley (2003). Here’s How to Reach Me. Brooks Publishing

12. Less than 20% of the youth account for more than 80% of the problems

13. Toward No Drug Abuse (TND) • SAMHSA Model program status • Lists individual, family, school, and community protective factors • 1/3 of the factors relate to having adequate information • The remaining 2/3 relate to developing social and emotional intelligence

14. CTC Survey Data for Haysville • Drug/Alcohol use above county and state averages on most indicators • Below averages on protective factors • Above averages on risk factors • Getting bad press • Of the 17 peer/individual, family, and school risk factors, 14 relate to social/emotional intelligence process factors, i.e. patterns of getting motivational needs met in unhealthy ways, failure to engage or relate effectively, or mismatch between environmental demands and coping skills

15. So what are the keys? • Self-awareness - understanding what makes me tick and stop ticking effectively • Responsibility - Skill-building in meeting my needs in healthy ways, recognizing and reversing negative attention patterns • Belief in my ability to act on what I know and learn • Hope that my effort will get me somewhere • Support - peer, school, family, and community support for positive change

16. Self-Efficacy • A person’s belief in their ability to act in a manner appropriate and necessary to deal with various situations (Bandura) • Social/Emotional skills in action • The difference between what you know, and what you do with what you know. • With regard to it’s impact on health and wellness, positive behavior change, and overcoming obstacles, self-efficacy is the most well-researched and strongly supported construct currently available. For a glimpse into the world of self-efficacy, go to www.des.emory.edu/mfp/self-efficacy.html

17. Self-Efficacy • Differs from attitudes, values and beliefs about others or situations – self-efficacy is focused on personal capabilities. • Transcends age, gender, type of problem, or socioeconomic status. • Self-efficacy is necessary for a person to act on what they know or learn. • It connects a person’s innate gifts, resources and potential with the demands of the real world • Is NOT self-esteem (see work by Roy Baumeister) • Strongly connected to failing forward and resilience

18. Process Solutions knows what works • Prairie View has a 52 year history in building self-efficacy. We are in the change business. • 14 year history in measuring outcomes in mental health and substance abuse treatment exploring the most effective approaches. • Just received Lattner Foundation grant to advance our work in outcomes • 13 year history in adventure-based programming • Present nationally at conferences • Published outcomes tools • Partnership with Project Adventure, the nation’s premier adventure training and programming organization • Ongoing calendar of training programs • Ongoing research programs • Proven results with local schools

19. Programs are effective when they… • Understand the impact of personality on behavior, engagement, learning, and motivation • Involve models of personality that go deep enough in explaining distress, negative attention, and many of the dynamics influencing drug/alcohol use • Place emphasis both on providing information AND building self-efficacy • Focus on potential and resiliency instead of what’s wrong with youth (i.e. strengths-based) • Focus on empowering youth to make positive changes rather than trying to control behavior • Include effective capacity-building for staff • Provide tools for culture change within systems

20. Our tools • Perceived Competence of Functioning Inventory (PCFI) – 16 item self-report assessment of self-efficacy • Motivational competencies* - setting and pursuing goals • Affective competencies – dealing with feelings about self • Cognitive competencies – judgment and critical thinking • Relational competencies* - connecting with others, giving and receiving support • General Level of Functioning – overall efficacy • Internal consistency of .88 - .90 • Test-retest reliability - .73 • Validated against the MCMI, Hope Scale, Ways of Coping Scale, Brief Symptom Index, and OQ-45 * Preliminary data from a large-scale longitudinal study at University of Minnesota on the impact of adventure-based interventions on drug/alcohol use shows that raising motivational and relational competencies are the two strongest predictors of success.

21. Our tools • PCFI 8-item scale for ages 10-13 • Same subscales as PCFI-16 • psychometrics not established yet

22. Our tools • Process Communication Model (PCM) • Transactional personality communication model • Defines 6 personality types, each with specific and predictable • Perceptual filters and preferred “channels of communication” • Character strengths • Psychological needs and motivators • Learning styles and environmental preferences • Second by second negative attention and sabotage behaviors • Likely racket emotions /authentic unresolved emotions • Typical clinical manifestations • Manual, training trajectory, and competency skills verification exists, so fidelity easier to manage

23. Experiential/Adventure Learning • Learning through doing • Clearly superior to “sit n git” learning – enhances retention and application of material • Engages multiple learning and personality styles • When done well, closely mimics real-life social and emotional challenges • Proven to positively impact key areas of self-efficacy • Published meta analysis proves effectiveness • Our data from 800 students completing similar programs over the last 3 years replicates these findings

24. Our success with youth • Analysis of 800 youth participating in our adventure course programs show statistically significant gains in self-efficacy with moderate to large effect sizes. • Numerous individual examples of transformed lives. • No comparison groups or follow-up data yet.

25. Our success with at-risk youth Grades 6-12 • Analysis of 204 at-risk students from 5 different schools (including Haysville Alternative) who have completed our school-based programs since 2005, and 23 matched controls. • Slight reduction in motivational, affective, cognitive, and relational capabilities for control group* • Significant improvements in all scales for treatment group • When asked to rate their confidence in coping without using drugs or alcohol – negligible change in control group, improvement in treatment group. Although the improvement was fairly small, it was 15 x larger than the change in the control group. * Our programs reversed a negative trend without changing curriculum or staffing. When we train staff and parents to use these tools, outcomes can be even more dramatic.

26. Why choose Process Solutions? • Local relationships and support that will be here for the long term • Clinical expertise and history • Proven tools, proven outcomes • Research experience and national partnerships for excellence • Shared values

27. What do you have to gain? • Impact on target behaviors, enhanced student efficacy and achievement, enhanced staff morale • Publicity and recognition for innovation • Opportunity and research data to obtain grant funding

28. Implementation Planstart small, demonstrate results, get funding to expand • Level 1: Direct services for at-risk youth • Level 2: Capacity building for staff • Level 3: Consultation/Coaching • Level 4: Advanced training to build local leaders

29. Level 1: Direct Services • LEEP program – Learning and Empowerment through Experiential Programs • Up to 15 students • 1 hour/week on-site groups for 6 weeks • Finish with 1 day on adventure course • Outcomes tracking for treatment and matched control group • Fidelity • Program manual • Weekly facilitator consultation group • Dual facilitator model

30. Level 2: Capacity Building • 2 day PCM training (second semester) • Content • Teach teachers the PCM model, which outlines basic skills in connecting, motivating, and reducing conflict in the classroom for all 6 personality types • Teach tools for empowering students to get their psychological needs and motivators met in healthy, productive ways (rather than with drugs/alcohol/violence) • Teach basics of transforming the classroom into an environment that supports all learning styles and engages all students • Could be applied for parents as well (perhaps even include parents?) • Fidelity • Manual and rigorous certification training • Regular group consultation among trainers • Dual trainer model

31. Level 3: Consultation/Coaching • PVPS staff on-site for regular consultation and coaching • 1 hour ten times during semester

32. Level 4: Advanced Training • For selected staff/students who will be mentors and consultants to rest of the system • Students selected/apply from LEEP program • 3-days customized training in using PCM and adventure based methods in the school to: • enhance impact of programs such as Challenge Day or other adventure-based programs, every day throughout the year. • meet diverse student needs • increase self-efficacy • break down barriers and stereotypes • build peer accountability culture

33. Funding Options • Funds that directly relate to these services • Safe and Drug Free Schools dollars • Staff Development funds • At Risk Student funds • Other options?

34. Anticipating resistance

35. Yes, but…. • Not many people will receive your services. How can that really make a difference? • At risk youth can lead the gangs, or they can lead the healthy initiatives. Connect with them first. • It’s not about Prairie View connecting with each person. It’s about initiating a culture change, moving toward a tipping point, empowering the right people to spread positive energy, finding and developing leaders, and gaining momentum. • Capacity building recognizes that those who deal with the kids, families, and community day in and day out are the ones who can really make a difference.

36. Yes, but…. • What about the kids who are already using? • You can’t stop them, but you can begin to create a culture and environment that is incompatible with drug/alcohol abuse • This is a long-term investment

37. Yes, but…. • When will we fit this all in? • How are at risk youth spending their time now? How productive is it? What are they accomplishing? • How much time are staff spending dealing with the distraction of disengaged youth, consequences of drug/alcohol use and other problems we are attempting to address? • The intended result is that everyone involved (staff and students) are making more productive use of their precious time.

38. Yes, but…. • What about the schools who aren’t involved…what can they do? • Assist in efforts to find funding • Work to develop community coalitions and partnerships • Volunteer to be a control group • Send one or two staff to our open enrollment seminars to test-drive what we do • Initial demonstration training should include staff from around the district so we can discuss this question during those two days • Promote the program and listen to what others are learning

39. Obtaining Collaboration • Built on existing relationship with the district’s education coordinator and principle from one of the grade schools • Proposal presented to district site council • Follow-up presentations and planning meetings with principles and counselors from the two participating schools

40. Research Design • Crossover design. Conditions crossed over at Spring semester • New elementary school - 5th graders – 2 classes (N = 27) experimental group, 2 classes (N = 28) control group • H.S. – Access Program for students designated as “at risk” based on grades and other behavioral indicators • 49 students Randomly assigned to experimental and control groups

41. Data Collection Protocol • PCFI at week 1, 4, and 6 of LEEP, day before and day after Adventure course, and semester end. • Control group: Week 1, 4, 6, and semester end • Behavioral data collected for prior year (2006) and current year to date. • GPA • Math and Reading test scores • Attendance (h.s. only) • Behavioral referrals (h.s. only) • Attendance (h.s. only)

42. Challenges along the way • Getting all the PCFI data collected • Designated internal staff person trained to collect all PCFI data for every condition • All PCFIs were completed in classroom setting, same time of day (even for adventure course) • PVPS facilitators brought data back to our lab for scoring • Our outcomes coordinator had constant contact with school to update on status of data collection, missing data, etc.

43. Challenges along the way • Changing plans mid-stream • H.S. staff didn’t show up for consultation, didn’t support LEEP program • Resources and funds diverted to elementary school for second semester

44. Challenges along the way • Gathering behavioral data • Took several months for school to collect and deliver all the data • Lots of missing data, no referral or attendance data for elementary students • Lots of passing the buck

45. What we’ve got so far! • Psychometrics of the PCFI • PCFI self-efficacy data for program and control groups • Associated behavioral data for program and control groups

46. Testing Internal Consistency • 49 high school students completed PCFI-16 at 4 time frames throughout semester. Program group (N = 25) also completed PCFI before and after day on adventure course • 55 5th grader students completed PCFI-8 at 4 time frames throughout semester. Program group (N = 28) also completed PCFI before and after day on adventure course

48. Implications • Reliability goes up with repeated administrations (would be expected) but stabilizes somewhat over time • As with our previous experience, initial administration with a group is less reliable than follow-up administrations (demand characteristics, lack of trust, etc.) • 8-item PCFI performed respectably, may present a viable alternative for younger children • Examining test-retest reliability, and subscale characteristics are the next steps