Germany

Last updated : 29.11.2024
Country of origin
USA
Last reviewed:
Age group
0-5 years
6-10 years
11-14 years
Target group
Parents of children's with behavioural problems
Programme setting(s)
Family
Level(s) of intervention
Indicated prevention

TripleP is a multi-level parenting and family support prevention strategy programme that aims to prevent severe children’s behavioural, emotional and developmental issues by enhancing parental knowledge, skills, and confidence. Triple P encompasses five levels with different types and intensity of interventions: from providing parents with access to information using print and electronic media (level 1) to highly targeted interventions for the most severe cases of family behaviour intervention (level 5). 

The five core principles of the intervention are creating a safe, engaging and positive learning environment, employing assertive discipline, having realistic expectations and prioritizing self-care as a parent. Most of the studies available in Europe assess level 4 of the intervention targeted to children with behavioural problems. However, in some studies, level 4 has been implemented at the universal level. Research conducted in Germany and Switzerland indicates positive outcomes for parental competence, primarily reported by mothers; however, no evidence is available to assess the programme's effectiveness on child-related outcomes as it’s only reported by parents. 

Links to this programme in other registries
Blue Prints - Triple P
Level 4 Standard Triple P - Early Intervention Foundation
Contact details

Jenna McWilliams
11 Market Street N, Indooroopilly, QLD, 4068, Australia
Contact: +6173236 1212
Email: PIES[at]triplep.net
 

 

Show link
0
Evidence rating
Possibly beneficial
Studies overview

Two RCTs in Germany have examined the effectiveness of Triple P at Level 4 (Heinrichs et al., 2014; Kim et al., 2021). The study by Heinrichs et al. (2014) targeted parents of 2.6 to 6-year-olds. The intervention group (n=186) participated in Triple P level 4 workshops and seminars, while the control group (n=93) underwent repeated assessments to monitor child development. According to mothers’ reports on children's behaviour, there was a significant effect after the intervention; however, this effect was not found in fathers. A significant reduction in dysfunctional parenting behaviour in mothers was maintained at the 4-year follow-up (d = 0.38), but effects on child behaviour problems were not sustained (d=0.19). Notably, all outcomes were parent-reported, with long-term benefits observed only in mothers. 

Kim et al. (2021) assessed the impact of Triple P on parenting behaviour and adolescent bullying. Families were randomized to either the intervention group (n=86) or the control group (n=94). After a 10-year follow-up, a notable reduction in bullying behaviours (0.259 standard deviations) was observed in adolescents whose parents had participated in the intervention. However, it is unclear how they achieved such a high retention rate over ten years. 

An RCT by Bodenmann et al. (2008) in Switzerland evaluated Triple P’s efficacy in improving parenting and child behaviour among 2-12-year-olds.  Fifty couples were randomly assigned to one of three conditions: Triple P programme, a distress prevention programme (CCET) or were left untreated. Mothers who attended the Triple P intervention at 1-year follow-up showed less parental dysfunctionality and a greater sense of parental competence compared to mothers from the other two groups. However, there were no significant effects of the intervention on fathers in any of the three groups. The child behaviour outcomes were only reported by parents, it is unclear what the control group received, and many outcomes were measured but statistical adjustments for these multiple comparisons were not applied. 

Little et al. (2012) conducted an RCT in Birmingham to evaluate the effectiveness of Triple P for children exhibiting problematic behaviour. The control group received services as normal (n=73) and the intervention group (n=73), the 8-week Triple Parent Program. There were no significant differences between the groups in any of the child-related outcomes. The authors noted that these results could be explained by low fidelity of implementation or low adherence to the programme.  

The report by Fives et al. (2013) was excluded from the assessment due to methodological issues, only a subsample of the original intervention group was analysed (n=59; 34% response rate). The analysis is within a group and not between groups, measures are not blind to intervention, there is no randomisation of participants, no assessment of participants for inclusion (targeted intervention), attrition has not been accounted for and the data included is only available for the post-test. 

 

References of studies

Studies Included in the Assessment:

Bodenmann, G., Cina, A., Ledermann, T., & Sanders, M. R. (2008). The efficacy of the Triple P-Positive Parenting Program in improving parenting and child behavior: A comparison with two other treatment conditions. Behaviour Research and Therapy, 46(4), 411–427. 

Heinrichs, N., Kliem, S., & Hahlweg, K. (2013). Four-Year Follow-Up of a randomized controlled trial of triple P group for parent and child outcomes. Prevention Science, 15(2), 233–245. https://doi.org/10.1007/s11121-012-0358-2

Kim, J. H., Hahlweg, K., & Schulz, W. (2021). Early childhood parenting and adolescent bullying behavior: Evidence from a randomized intervention at ten-year follow-up. Social Science & Medicine, 282, 114114. https://doi.org/10.1016/j.socscimed.2021.114114

Studies not Included in the Assessment:

Fives, A., Pursell, L., Heary, C., Gabhainn, S. N., & Canavan, J. (2014). Parenting Support for Every Parent: A population-level evaluation of Triple P in Longford Westmeath. Final report. https://aran.library.nuigalway.ie/bitstream/10379/14832/1/parenting_sup…

Steketee, M., Jonkman, H., Naber, P., & Distelbrink, M. (2021). Does Teen Triple P Affect Parenting and the Social and Emotional Behaviours of Teenagers? A Study of the Positive Parenting Programme in the Netherlands. Behaviour Change, 38(2), 95–108. doi:10.1017/bec.2021.2

Graaf, I. de, Bohlmeijer, E., Blokland, G., & Tavecchio, L. (2009a). Helping Families Change. The adoptation of the Triple P – Positive Parenting Program in the Netherlands. Chapter 5: What are the results of Group and Standard Triple P for parents and children in the Dutch mental health care and youth care? (PhD). Utrecht: University of Amsterdam. 

Schapping, R., De Graaf, I.M., Reijneveld, S.A., Effectiviteit van Triple P in Nederland: stand van zaken en controverse. Kind Adolescent, DOI 10.1007/s12453-017-0140-0 (https://www.researchgate.net/profile/SaReijneveld/publication/316455304… nd_van_zaken_en_controverse/links/5e159cad92851c8364ba8be7/Effectiviteitvan-Triple-P-in-Nederland-stand-van-zaken-en-controverse.pdf).
 

Countries where evaluated
Germany
Switzerland
United Kingdom
Protective factor(s) addressed
Family: attachment to and support from parents
Family: Parental monitoring (supervision)
Family: positive family management
Risk factor(s) addressed
Family: aggressive or violent parenting
Family: family management problems
Family: low parental education
Family: neglectful parenting
Family: other
Outcomes targeted
Emotion regulation, coping, resilience
Positive relationships
Social behaviour (including conduct problems)
Description of programme

Level 4 is an intensive, eight-session parenting program delivered in various formats (individual, group, or self-help) for parents of children with significant behavioural challenges. Parents receive five group sessions of parent training (each session lasting two and a half hours). Upon completion of the group sessions, parents participate in three individual telephone consultations (15–30 min duration each).  The intervention aims to teach positive parenting strategies to encourage children’s self-regulation, manage misbehaviour and enhance social competence. During the training, are encouraged to practice these strategies and reflect on their effectiveness.

Implementation Experiences
Feedback date
Last updated : 13.11.2020
Country of origin
Germany
Last reviewed:
Age group
6-10 years
11-14 years
Target group
Children/young people (8 to 12 years)
Programme setting(s)
Community
Family
Level(s) of intervention
Selective prevention

TRAMPOLINE is a selective prevention programme that aims to prevent substance use disorders (SUD) in children from families affected by substance use. It is a nine-session addiction-focused modular group programme for children aged 8 to 12 years with at least one substance-using parent. The main objective of the programme is to teach participants effective strategies to cope with stress;  it seeks to reduce the psychological stress resulting from parental substance abuse or dependency by extending children´s knowledge about alcohol and drugs, their effects on people and the consequences of substance-related disorders for affected persons and their family. Moreover it aims to improve feelings of self-worth and self-efficacy, and to help develop a positive concept of self.

The programme evaluation focuses on factors derived from literature that promote resilience and reduce risk for SUD in children of alcohol or drug using parents; given the age of the children, and funding constrictions, substance use was not directly investigated.

Links to this programme in other registries
Germany - Green List Prevention
Contact details

Dr. rer. nat. Diana Moesgen
MSc. Psych., Psych. Psychotherapeutin
Deutsches Institut für Sucht-und Präventionsforschung
Katholische Hochschule NRW
Phone: 0221-7757-173
Fax: 0221-7757-180
Email: d.moesge[a]katho-nrw.de
Website: www.katho-nrw.de/katho-nrw/forschung-entwicklung/institute-der-katho-nrw/disup/

Prof. Dr. Michael Klein
German Institute on Addiction and Prevention Research
Wörthstraße 10
Köln Germany
UKE Hamburg
Email: info[a]uke.de
Website: www.dzskj.de

Prof. Dr. med. Rainer Thomasius
Universitätsklinikum Hamburg-Eppendorf
Zentrum für Psychosoziale Medizin
Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters (DZSKJ)
Hamburg
Tel.: 040-7410-52206
Fax: 040-7410-56571
Email:thomasius[a]uke.de
http://www.projekt-trampolin.de/

Evidence rating
Additional studies recommended
Studies overview

The programme has been evaluated in two multicentre RCTs in Germany.

The first German multicentre RCT (2012) was conducted among 218 children from substance-affected families. In total, 27 outpatient facilities from different settings, distributed equally in Germany, delivered the intervention. Six months after the intervention, the children of both the intervention and the control groups had significantly less avoidable stress management compared to their baseline (general and addiction-specific), less constructive palliative emotion regulation, less negative stress management strategies both general and search specific, lower psychological burden, improved cognitive skills, peer acceptance, improved self-esteem, an overall improved self-concept and a better quality of life in relation to parents and autonomy. One of the effects can only be identified in the short term: an improvement in mental well-being cannot be recognized after six months.

Because of high adherence rates the authors assume that the evidence of efficacy of "trampoline" can be attributed to the program and that confounding can be ruled out. The intervention did change both the cognitions of children about what is happening in the addiction family context and their own role in it, as well as the emotions of children, especially their psychological distress, but above all, six months later, it keeps dropping. Both effects are still statistically significant, even when adjusted for the influence of age and gender.

The most pronounced effects of the programme are shown in the reduced burden of parental addiction with a small effect (ES: 0.14) and with a medium effect (ES: 0.64) on a greater knowledge of substances. There is an approximately average effect (ES: 0.31) in the reduction of psychological stress.

The second German multicentre RCT (2019) was conducted with 8 to 12 years old children of substance using parents in 27 German counselling centres. The results for the preventive group intervention “TRAMPOLINE” (a psycho-educational (PE) program) were compared with a non‐educational (NE) group. Children from both groups reported reduced mental distress, reduced avoidance in coping with family stress, improved self‐perceived autonomy, and a better parent–child relationship. It was concluded that both forms of intervention (PE and NE) can generate positive changes in children with substance using parents. However, it was not possible to demonstrate that PE was a more efficient type of intervention. The conclusions also state that the study is slightly underpowered, which makes it difficult to detect statistically significant effects.

References of studies

Outcome evaluations/results:

Bröning S., Sack M.P.; Haevelmann A.; Wartberg L.; Moesgen D.; Klein M. and Thomasius R. (2019). A new preventive intervention for children of substance‐abusing parents: Results of a randomized controlled trial.

Bröning, S., Wiedow, A., Wartberg, L., Ruths, S., Haevelmann, A., Kindermann, S.S., Moesgen, D., Schaunig-Busch, I., Klein, M. & Thomasius, R. (2012). Targeting children of substance-using parents with the community-based group intervention TRAMPOLINE: a randomized controlled trial – design, evaluation, recruitment issues. BMC Public Health, 12, 223 (1-11).

Klein, M., Moesgen, D., Bröning, S. & Thomasius, R. (2013). Kinder aus suchtbelasteten Familien stärken. Das „Trampolin“-Programm. Göttingen: Hogrefe.

 

Process evaluation studies:

Haevelmann, A., Bröning, S., Klein, M., Moesgen, D., Wartberg, L. & Thomasius, R. (2013). Empirische Qualitätssicherung in der Evaluation des Gruppenangebots „Trampolin“ für Kinder aus suchtbelasteten Familien. Suchttherapie, 14 (3), 128-134.

 

Concept papers/other:

Bröning, S., Kumpfer, K., Kruse, K., Sack, P.M., Schaunig-Busch, I., Ruths, S., Moesgen, D., Pflug, E., Klein, M. & Thomasius, R. (2012). Selective prevention programs for children from substance-affected families: a comprehensive systematic review. Substance Abuse Treatment, Prevention, and Policy, 7, 23.

Bröning, S., Moesgen, D., Klein, M. & Thomasius, R. (2012). Ressourcenorientiertes Arbeiten mit Kindern aus Suchtfamilien. Das Beispiel "Trampolin". Psychotherapie im Dialog, 4, 44-48.

Bröning, S., Moesgen, D., Klein, M. & Thomasius, R. (2013). Working with children from substance-affected families: the community-based group intervention TRAMPOLINE [Trabajar con hijos de familias drogodependientes: la intervención de grupo TRAMPOLINE radicada en la comunidad]. Pedagogía Social, 21, 67-84.

Bröning, S., Moesgen, D., Wartberg, L., Haevelmann, A., Keller, K. et al. (2012). Trampolin – Konzeption und Evaluation eines modularen Präventionskonzeptes für Kinder aus suchtbelasteten Familien. Abschlussbericht an das Bundesministerium für Gesundheit.

Exchange on Drug Demand Reduction Action (EDDRA), EMCDDA. Trampoline (German: ‘’Trampolin’’). Summary.

Moesgen, D., Bröning, S., Ruths, S., Pflug, E., Schaunig-Busch, I., Thomasius, R. & Klein, M. (2012). Trampolin – Ein Präventionsprogramm für Kinder aus suchtbelasteten Familien. Sucht, 58 (4), 277-285.

Ruths, S., Moesgen, D., Bröning, S., Klein, M. & Thomasius, R. (2013). Präventionsangebote für Kinder aus suchtbelasteten Familien – eine bundesweite Bestandsaufnahme. Suchttherapie, 14 (1), 22-28.

Trampolin. (n.d.). Trampolin - Kinder aus suchtbelasteten Familien entdecken ihre Stärken [website].

 

Studies excluded from the rating process:

Moesgen, D,; Ise, K.; Dyba, J. and Klein, M. (2019). Evaluation of the mindfulness-augmented “Trampoline” programme–a German prevention programme for children from substance-involved families tested in a cluster-randomized trial.

 

Countries where evaluated
Germany
Protective factor(s) addressed
Individual and peers: Problem solving skills
Individual and peers: skills for social interaction
Risk factor(s) addressed
Family: aggressive or violent parenting
Family: Family history or involvement with substance abuse/problem behaviour
Family: neglectful parenting
Family: parental attitudes favourable to alcohol/drug use
Outcomes targeted
Emotional well-being
Other mental health outcomes
Positive relationships
Relations with parents
Description of programme

TRAMPOLINE was developed for children aged 8-12 years that have at least one substance-abusing or -dependent caregiver. The intervention is specifically geared to the issues and needs of children of substance-abusers (COS). The name TRAMPOLINE was chosen because it creates positive associations in children, but also because it combines the ability to jump higher with the protection of a soft landing. The programme aims to empower the participation of children and at the same time to provide them with support and a safe place.

The TRAMPOLINE manual includes nine weekly 90-minute modules for children, as well as two optional sessions for their parents. The programme modules include: 1 – getting to know each other, 2 – self-worth: how I feel about myself, 3 – alcohol and/or drug problems in my family, 4 – knowledge: what I need to know about drugs and addiction, 5 – handling difficult emotions, 6 – self-efficacy: what I can do to solve problems, 7 – learning new patterns of behaviour in my family, 8 – what I can do to find help and support, and 9 – a positive good-bye.

All subjects are delivered in an interactive and age-appropriate way, with a large proportion of the sessions devoted to exercise and role-play. Special attention is paid to devise small rituals and a recurring structure to the sessions, both of which children in substance-affected homes often lack. Each session follows the same structure: it begins with an exchange on how children feel that day, followed by a discussion of the “homework” from the previous session; the new topic is then introduced, and developed through a variety of didactics. In between learning activities, there are “fun-and-play” activities such as songs or creative exercises. The sessions end with a relaxation exercise.

The parent sessions can be attended independently; providers should not assume that parents from volatile families will come to both, or even one, of the sessions. The first session, at the start of the programme, seeks to inform parents about the programme and about risk and protective factors children face when growing up in a substance-affected environment. Parents share the hopes they have with regards to living with their children, and are encouraged to consider parenting skills and their importance for their children. The second session, at the end of the programme, seeks to inform parents on how the programme went (from the trainer’s perspective), to answer questions about issues that may have come up at home in the course of the programme, and to sensitize parents to the needs of children in substance-affected families and how caregivers may be empowered in the future. Parents are encouraged to seek and accept further support in their parenting role. The manual for parents provides questions, group discussion and practical exercises.

The programme evaluation explores the role of psycho-education on children’s well-being by comparing the effects of TRAMPOLINE to an intervention for COS that is very similar with regard to setting, dose, and trainer qualification, but does not include addiction-related content or activities. We hypothesize that addiction-specific education, activities and role play will enhance the effectiveness of a prevention program compared with a prevention program without educational components.

Implementation Experiences
Feedback date
Contact details

Prof. Dr. Michael Klein, Deutsches Institut für Sucht- und Präventionsforschung, Katholische Hochschule NRW, Wörthstraße 10, 50668 Köln, German, Mail mikle[a]katho-nrw.de

Prof. Dr. Rainer Thomasius, Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters, Universitätsklinikum Hamburg-Eppendorf, Zentrum für Psychosoziale Medizin, Martinistraße 52, 20246 Hamburg, Germany, Mail: thomasius[a]uke.de

Training offers: requests via website http://www.projekt-trampolin.de/#/f/6 or via E-Mail: weiterbildung[a]katho-nrw.de, mikle[a]katho-nrw.de (Trampolin Plus) or sekretariat.dzskj[a]uke.de (basic certificate)

Certified trainers: via website http://www.projekt-trampolin.de/#/k-j/4-2

Main obstacles

With respect to individual professionals

Almost none. Some professionals were not convinced about certain exercises

With respect to social context

None

With respect to organisational and economic context

Recruitment of children from substance-involved families (hard-to-reach target group)

How they overcame the obstacles

With respect to individual professionals

Ask to implement as stated in manual for piloting phase; provide more degrees of freedom for later implementations

With respect to organisational and economic context

Time and personnel resources

Lessons learnt

With respect to individual professionals

Provide more degrees of freedom for implementation, e.g. regarding time frame, exercises, etc.

With respect to organisational and economic context

Planning sufficient time and personnel resources

Strengths

Evidence-based programme for children from substance-involved families

Weaknesses

Sometimes overloaded, too many exercises for time frame given

Opportunities

Flexible implementation possible

Threats

Sustained financing unclear: each institution is responsible for its own financing

Recommendations

With respect to individual professionals

University degree in social work, psychology or similar and/or professional experience in working with substance-affected families

With respect to organisational and economic context

Ensure sufficient time and personnel resources; obtain funding

Note from the authors

Trampoline - A Modular Prevention Program for Children from Substance-Abusing Families

Number of implementations
1
Country
Germany
Last updated : 07.05.2019
Country of origin
Germany
Last reviewed:
Age group
15-18/19 years
20-25 years
Target group
14 – 25 years olds in school, university or youth group
Programme setting(s)
School

REBOUND is a media-based life skills and risk education programme developed for 14 – 25 year-olds in school, university or youth groups in school settings. The programme is based on cooperative learning; it is facilitated by teachers and other professionals, and supported by peer mentors. It aims to promote risk competence and positive norm-building in social groups.

REBOUND seeks to build positive developmental assets such as cognitive and emotional competence, self-perception of one’s strengths and self-efficacy. Moreover it seeks to strengthen autonomous decision-making, positive group norms, and risk awareness. It aims to intervene at the experimentation phase in users, and to strengthen abstinence values in non-users.

Links to this programme in other registries
Germany - Green List Prevention
Contact details

Maximilian von Heyden
Email: maximilian.von-heyden[a]charite.de

Evidence rating
Additional studies recommended
Studies overview

The programme has been evaluated in one quasi-experimental study in Germany among 9th and 10th graders (n = 723 students in five schools and 46 classes) in academic and vocational high school. A controlled study was conducted with repeated measurement before and after the intervention (4-6 months). The study showed overall significant lower incidence rated of drunkenness, improved knowledge about psychoactive substances, lower personal and general tobacco risk perception among users and lower general tobacco and cannabis risk perception in non-users. In academic high school there was a decrease in 30-day prevalence for alcohol and cannabis, and improved knowledge about psychoactive substances. In vocational high school there was an increase in the relative alcohol risk perception. Concerning the outcomes, some iatrogenic effects were reported (users of tobacco rated their tobacco consumption as less dangerous than tobacco users in the control group, probability for the initiation of the first drunkenness for boys in the intervention group is higher than in the control group).

REBOUND is currently being adjusted in accordance with the results from the first evaluation; a new evaluation RCT is expected to be published in 2019/2020. The new version will include an e-health intervention.

References of studies

Outcome evaluation/results:

Jungaberle, H., & Nagy, E. (2015). Pilot Evaluation Study of the Life Skills Program REBOUND: Effects on Substance Use, Knowledge About Substances, and Risk Perception. SAGE Open.

 

Concept papers/other:

Kröninger-Jungaberle, H., Nagy, E., Heyden, M. von, & DuBois, F. (2015). REBOUND: A media-based life skills and risk education programme. Health Education Journal, 74(6), 705–719.

Countries where evaluated
Germany
Protective factor(s) addressed
Family: attachment to and support from parents
Individual and peers: individual/peers other
Risk factor(s) addressed
Family: parental attitudes favourable to alcohol/drug use
Individual and peers: favourable attitude towards alcohol/drug use
School and work: other
Outcomes targeted
Education
Academic performance
Other educational outcomes
Emotional well-being
Other mental health outcomes
Positive relationships
Relations with parents
Alcohol use
Use of illicit drugs
Smoking (tobacco)
Substance-related behaviours
Other behaviour outcomes
Description of programme

REBOUND is a novel media-based life skills and risk education programme developed for 14 – 25 year-olds in school, university or youth groups in school settings. The programme is based on cooperative learning; it is facilitated by teachers and other professionals, and supported by peer mentors. The curriculum is centred on ‘explorative film work’, with short films/videos depicting risk behaviours and life challenges.

REBOUND aims to build positive developmental assets such as cognitive and emotional competence, self-perception of one’s strengths and self-efficacy. Moreover it seeks to strengthen autonomous decision-making, positive group norms, and risk awareness. It aims to intervene at the experimentation phase in users, and to strengthen abstinence values in non-users.

It has been developed to achieve both short- and long-term effects, and includes cognitive, developmental and environmental dimensions. The first objective is strengthening risk competence; it encompasses self-reflection, risk knowledge, the wish to control substance use, and expanded life orientation. The second objective is supporting young people in strength recognition and reflective decision-making; it includes developing critical attitudes towards peer beliefs and media models.

The programme consists of a course with sixteen 90-minute-units, ten of which focus on psychosocial strength (resilience), and six on risks of alcohol and other drugs. It is implemented in the 9th and 10th grades, and delivered over a 4-6 months period. Implementation is supported by a mentoring system, a voluntary eLearning component, and tools for organisational development. REBOUND materials consist of (i) a facilitator’s manual including DVDs with short films, implementation materials and parent’s hand-outs, (ii) a student’s book, and (iii) a card box for film work. All the materials are available at the online tool box on the programme’s website.

REBOUND is a health promotion/prevention programme entirely developed in collaboration with those for whom it is intended, i.e. students, facilitators, and school administrators. The current programme focuses on substance abuse prevention. Future versions are planned, which also address media dependency, including excessive gaming, Internet, television, and mobile phone use.

The evaluated version (0.5) has been adjusted in response to the results of the pilot evaluation. The current version (1.1) places emphasis on normative aspects and environmental prevention. Additionally, an online training programme was developed for professional exchange. A new version (2.0) is planned, with the optional implementation of a positively evaluated evidence-based e-Health intervention. The second RCT will be conducted in 2019/2020.

Last updated : 07.05.2019
Country of origin
No country of origin defined
Last reviewed:
Age group
0-5 years
6-10 years
11-14 years
Target group
Children aged 5-14 years
Programme setting(s)
School
Level(s) of intervention
Selective prevention
Universal prevention

The Vienna Social Competence Training programme is a multimodal training programme for school classes which aims to strengthen pupils’ sense of class commitment, the perception of responsibility and at fostering non-bullying and nonaggressive behaviour in conflict situations. Pupils are trained to become aware of their social role in conflict situations (e.g. as perpetrator, victim or spectator), and of their responsibility to bring about a peaceful situation.

programme consists of 13 lessons over three phases: Impulses and Group Dynamics; Reflection; Action. The first and last phase contain six lessons of 1.5 hours each, and the Reflection phase is a single 1.5-hour lesson enabling the students and trainer to reflect on what has been learned. Students plan goal-setting activities and the remaining lessons’ content are planned collectively by the group according to the programme’s global goal of social competence and its two main principles of participation and behavioural enrichment.

Links to this programme in other registries
No link
Contact details

Prof. Dr. Christiane Spiel, Ph.D.
Faculty of Psychology
University of Vienna
Vienna
Austria
Email: Christiane.speil[a]univie.ac.at

Evidence rating
Possibly beneficial
Studies overview

The programme has been evaluated in two cluster randomised controlled trials in Austria and three quasi-experimental studies, one each in Germany, Cyprus and Turkey.

In one Austrian trial, two classes from a Viennese vocational school were randomly allocated to the intervention group while two classes from the same school served as the control group. In total, 112 students, aged 15 to 21 years, participated. Significant differences were detected only in the short-term (post-test), not follow-up for the democracy outcomes. Aggression showed a positive trend and only approached significance at both time-points.

In the second Austrian trial, 13 schools were randomly allocated to the intervention and 13 to control. 2042 students with a mean age of 11.7 years participated. The study found a significant intervention effect on self-reported cyberbullying and cyber victimisation. Both decreased in the intervention group; cyberbullying increased in the control group while cyber victimisation remained constant.

In the German study, 184 students from 4 intervention and 3 control classes. For peer-reported change in aggression, there was a significant effect at posttest but not at follow-up. An extension study collected data from one more intervention school making the total sample 283, to examine the effect on behavioural dispositions. There was a positive on behavioural disposition at posttest, however the control group caught up by follow-up.

The Cypriot study included 1752 students with a mean age of 12.6 years from 3 intervention and 3 control schools. Self-reported aggressive behaviour and victimisation were measured. The analyses revealed that the programme effects differed depending on the grade level of the students. Overall, the programme was more effective for grade 7 compared with grade 8 students. 2/5 measures of perpetration and 4/5 measures of victimisation had a significant positive intervention effect for Grade 7. In grade 8, bullying and victimisation increased more in the intervention group compared with the control group at posttest, but also steeper decreased at follow-up.

The Turkish study included 642 students, with a mean age of 10.06 years, from 6 schools. Self-reported perpetration and victimisation increased in the two intervention groups compared to control group between pre and post-test, but also decreased between post-test and follow-up.

References of studies

*Atria, M., and Spiel, C. (2007). Viennese Social Competence (ViSC) Training for Students: Programme and Evaluation. In J. E. Zins, M. J. Elias, & C. A Maher (Eds.). Bullying Victimization and peer harassment: a handbook of prevention and intervention, 179-198. New York: The Haworth Press.

Doğan, A., Keser, E., Şen, Z., Yanagida, T., Gradinger, P., & Strohmeier, D. (2017). Evidence Based Bullying Prevention in Turkey: Implementation of the ViSC Social Competence Program. International Journal of Developmental Science, 11(3-4), 93-108.

*Gollwitzer, M., Eisenbach, K., Atria, M., Strohmeier, D., & Banse, R. (2006). Evaluation of Aggression-Reducing Effects of the “Viennese Social Competence Training”. Swiss Journal of Psychology, 65 (2), 125-135.

*Gollwitzer, M., Banse, R., Eisenbach, K., & Naumann, A. (2007). Effectiveness of the Vienna Social Competence Training on Explicit and Implicit Aggression. Evidence from an Aggressiveness-IAT. European Journal of Psychological Assessment, 23 (3): 150-156.

*Gradinger, P., Yanagida, T., Strohmeier, D., & Spiel, C. (2015). Prevention of Cyberbullying and Cyber Victimization: Evaluation of the ViSC Social Competence Programme. Journal of School Violence, 14(1), 87-110.

Solomontos-Kountouri, O., Gradinger, P., Yanagida, T., & Strohmeier, D. (2016). The implementation and evaluation of the ViSC program in cyprus: challenges of cross-national dissemination and evaluation results. European Journal of Developmental Psychology, 13(6), 737-755.

Countries where evaluated
Austria
Germany
Protective factor(s) addressed
Individual and peers: skills for social interaction
Risk factor(s) addressed
Individual and peers: other
Outcomes targeted
Bullying
Other behaviour outcomes
Description of programme

The Vienna Social Competence Training programme is a multimodal training programme for school classes that aims to strengthen pupils’ sense of class commitment, the perception of responsibility and at fostering non-bullying and nonaggressive behaviour in conflict situations. The structure and outline of the programme rests on two principles, enrichment of the behavioural repertoire and participation. In particular, ViSC aims at reducing hostile attribution biases and at increasing the salience and cognitive accessibility of “socially competent” nonaggressive behavioural response options in conflict situations. Pupils are trained to become aware of their social role in conflict situations (e.g. as perpetrator, victim or spectator), and of their responsibility to bring about a peaceful situation. Furthermore, class commitment and willingness to display socially responsible behaviour is strengthened.

The intervention consists of 13 lessons delivered over 13 consecutive weeks and divided into three phases: Impulses and Group Dynamics; Reflection; and Action. The Impulses and Group Dynamics phase consists of six lessons of 1.5 hours each. The main aim is to strengthen youth competence in critical situations, addressing different perspectives of social situations and finding alternative ways of handling situations. The lessons take the form of discussions and role-plays. The Reflection phase consists of a single lesson of 1.5 hours and gives the students and trainer an opportunity to reflect on what they have learned. Students must write about how they have profited from the programme so far. The final Action phase consists of six lessons of 1.5 hours each. Pupils and trainers define how they want to benefit from the remaining lessons. Goal-setting activities are planned and the group collectively plans the rest of the lessons’ content according to the programme’s global goal (social competence) and its two main principles (participation and behavioural enrichment).

Implementation Experiences
Feedback date
Contact details

Olga Solomontos-Kountouri
o.solomontos-kountouri[a]theo.ac.cy

Main obstacles

With respect to individual professionals

For us, these were the professionals from the Ministry of Education who are responsible for providing professional advice to schools concerning bullying and other behavioural problems. At first they were very willing to learn a new programme and to implement it in schools. However, after the pilot implementation they only wanted to supervise the programme, and they decided without consultation that only the intervention part was needed. They proceeded to issue a circular advising all schools about the intervention part. 

With respect to social context

For us, these were mainly the teachers. Teachers generally do not want to spend any extra time being trained or preparing a new programme. They would like to learn something quickly and do something easy. Some teachers do not accept that they have to take responsibility for bullying issues. However, many other teachers are very sensitive and they really want to learn skills and practices for dealing with critical situations.

With respect to organisational and economic context

We piloted the programme without a budget, based on voluntary work from our Masters students and our own free time. Then for the official implementation we kept the cost really low.

How they overcame the obstacles

With respect to individual professionals

First, I ensured that the Minister of Education and his advisors read and understood the results from the pilot study, which indicated that the programme as a whole is very promising in reducing bullying and victimisation in schools. Second, I put together a carefully considered proposal for how I could offer the programme to any school in need of an anti-bullying programme. I trained my professional group (colleagues and Masters students) to become the trainers for the schools.

With respect to social context

I am very open to accepting any concern or disagreement and to discussing these and providing evidence (this is an evidence-based and evaluated programme). I persuaded the teachers how useful the programme would be, first for them and then for the pupils. I also encouraged the more sensitive teachers to take active roles. I set a rule that the programme would be implemented in schools in which the majority of teachers would like it implemented.

With respect to organisational and economic context

We kept the cost really low. We implemented the programme because we offer a very special social service to schools. I do not know how long I can keep it like this. The very good relations I have with schools and the need for such a programme keeps me going.

Lessons learnt

With respect to individual professionals

First, be very professional and clear about the roles of each parts of the programme and keep to them. Second, maintain good relations with the policymakers. Third, insist on meeting your targets.

With respect to social context

Implement the programme in schools in which the majority of teachers would like it implemented. Do not impose the programme on a school. The long, steady and precise implementation in a few schools each year keeps up the good name of the programme. Do not implement the programme in more schools than can be supervised by your group.

With respect to organisational and economic context

Using Masters students can help the programme survive. It is very useful for them and for their curriculum vitae to be part of the group. In this way, despite a low budget, I still manage to offer the programme to the schools.

Strengths

Evidence-based programme; pilot the programme in the new country before implementation; showcase the positive results this programme can offer; keep the implementation very precise; do not change the basic principles or the content of the programme; make only necessary adjustments; and be flexible with people but stick to the programme.

Weaknesses

Lack of funding; time consuming; and difficulty in maintaining the programme in the school — usually after three years the school gets tired of the programme.

Opportunities

Networking; and gaining a good reputation in both the scientific community and the practitioners’ community.

Threats

Some people may steal the program and use it in their own unprofessional ways.

Recommendations

With respect to individual professionals

Set clear targets from the beginning. Ensure the ownership of the programme. Discuss clearly individuals’ roles.

With respect to social context

Have clear aims: what will the benefits be and who will benefit in the long run?

With respect to organisational and economic context

Find volunteers and faithful collaborators.

Number of implementations
1
Country
Cyprus
Last updated : 09.01.2024
Country of origin
USA
Last reviewed:
Age group
0-5 years
6-10 years
11-14 years
Target group
Preschool children aged 3-4 and school aged children aged 5-14
Programme setting(s)
School
Level(s) of intervention
Universal prevention

Second Step is a violence prevention programme with developmentally appropriate curriculum for children Pre-K (4 years of age) through 9th grade (14 years of age). The programme addresses attitudes and behaviours that contribute to violence by teaching children impulse control and anger management. Aggressive attitudes and behaviour are replaced with increased empathy, self-awareness, social competence and pro-social responses to conflict.

Links to this programme in other registries
Germany - Green List Prevention
Contact details

Ms. Joan Duffell
2203 Airport Way South, Suite 500
Seattle, WA 98134-2027
USA
Phone: 1 (206) 343-1220

Evidence rating
Possibly beneficial
Studies overview

The programme has been evaluated in one quasi-experimental in Norway and one randomised controlled trial in Germany. The Norwegian study, testing the adaption called ‘Steg for Steg’, used an age-cohort design and 1153 students from Grade 5 to 7 (10-12 years) from 11 schools participated. The German study, testing the adaption called ‘Faustlos’, randomised 44 classes with 718 children aged 5-6 years.

There were significant effects in the Norwegian study but few in the German evaluation. The programme increased social competence and reduced externalising problems. In the Norwegian study. there was a significant positive effect on social competence among grade 5 students (ES: 0.18) and girls in grade 6 (ES: 0.32). For externalising behaviour, only boys in grade 5 showed a significant improvement (ES: 0.27). There was no effect on internalising behaviour.

In the German study, only 3 of 30 outcome measures had a significant intervention effect. There was a reduction in self-reported fear of loss of control, parent reported anxiety and depression and internalising behaviour. No significant impact was found on any teacher-reported outcome.

References of studies

Beland, K., & Sylvester, L. (1997). Teacher and Student Evaluation of Second step, Middle School/Junior High 1995-1996 Pilot Project Seattle: Committee for Children.

Frey, K. S, Nolen, S. B., Edstrom, L. V., & Hirschstein, M. K. (2005). Effects of a school-based social-emotional competence programme: linking goals, attributions, and behavior. Accepted for publication in the Journal of Applied Developmental Psychology.

Frey, K. S., Nolen, S. B., Edstrom, L. V., and Hirschstein, M. K. (2005). Effects of a school-based social-emotional competence programme: Linking children's goals, attributions, and behavior. Applied Developmental Psychology, 26, 171-200.

Grossman, D. C., Neckerman, H. J., Koepsell, T. D., Liu, P., Asher, K. N., Beland, K., Frey, K, & Rivara, F. P. (1997). Effectiveness of a violence prevention curriculum among children in elementary school: A randomized controlled trial. JAMA, 277, 1605-1611.

*Holsen, I., Smith, B. H., & Frey, K. S. (2008). Outcomes of the social competence programme Second Step in Norwegian elementary schools. School Psychology International, 29(1), 71-88.

McMahon, S. D., Washburn, J., Felix, E., Yakin, J., and Childrey, G. (2000). Violence prevention: Programme effects on urban preschool and kindergarten children. Applied and Preventive Psychology, 9, 271-281.

Moore, B., & Beland, K. (1992). Evaluation of Second Step, Preschool-Kindergarten: A Violence-Prevention Curriculum Kit, Summary Report. Seattle, Washington: Committee for Children.

Orpinas, P., Parcel, G.S., McAlister, A., and Frankowski, R. (1995). Violence prevention in middle schools: A pilot evaluation. Journal of Adolescent Health, 17, 360-371.

*Schick, A., & Cierpka, M. (2005). Faustlos: Evaluation of a curriculum to prevent violence in elementary schools. Applied and Preventive Psychology, 11(3), 157-16.

Social and Character Development Research Consortium (2010). Efficacy of Schoolwide Programmes to Promote Social and Character Development and Reduce Problem Behavior in Elementary School Children (NCER 2011-2001). Washington, DC: National Centre for Education Research, Institute of Education Sciences, U.S. Department of Education.

Sylvester, L., Beland, K., & Frey, K. S. (1997). A preliminary evaluation of Second Step, Middle School/Junior High: Changes in social attitudes and knowledge. Seattle, Washington: Committee for Children.

Sylvester, L., & Frey, K. (1997). Summary of Second Step Programme Evaluations. Seattle, WA: Committee for Children.

Taub, J. (2001). Evaluation of the Second Step violence prevention programme at a rural elementary school. School Psychology Review, 31(2), 186-200.

Van Schoiack-Edstrom, L., Frey, K., and Beland, K. (2002). Changing adolescent’s attitudes about relational and physical aggression: An early evaluation of a school-based intervention. School Psychology Review, 31(2), 210-216.

Countries where evaluated
Germany
Norway
Protective factor(s) addressed
Individual and peers: clear morals and standards of behaviour
Individual and peers: individual/peers other
Individual and peers: Problem solving skills
Individual and peers: refusal skills and decision making
Individual and peers: skills for social interaction
Risk factor(s) addressed
Individual and peers: anti-social behaviour
Individual and peers: favourable attitudes towards anti-social behaviour
Individual and peers: other
Outcomes targeted
Emotional well-being
Emotion regulation, coping, resilience
Other behaviour outcomes
Description of programme

The Second Step curriculum teaches skills to reduce impulsive and aggressive behaviour in children and increase their level of social competence. It uses developmentally appropriate lessons at each grade level Preschool/Kindergarten (4-5 years of age), Grades 1-3 (6 – 8 years of age), Grades 4-5 (9 – 10 years of age) and Middle School/Junior High (11 – 14 years of age), to cover the same three skill units, Empathy, Impulse Control, and Anger Management. Lessons for Pre-K (4 years of age) through fifth grade (10 years of age) consist of assessment of scripted social situations using stories and pictures, discussion of appropriate responses and role-playing. The Middle School/Junior High curriculum uses the same teaching mediums but deals with more difficult issues faced by older children, i.e. gangs, gossip and peer pressure. The more advanced curriculum also introduces the concept of goal setting.

Second Step also offers families a video-based parent programme called A Family Guide to Second Step: Parenting Strategies for a Safer Tomorrow. It is designed to help parents and caregivers of Second Step students apply prosocial skills to parenting situations. The family component familiarizes parents with the Second Step curriculum, assists them with reinforcing the skills at home, and gives families the skills to communicate feelings, solve problems, control anger, and deal with conflict.

Intervention Variation

Steg for Steg is a version of the programme that is translated and adapted for the Norwegian setting. Lessons are taught once a week or every second week.

Faustlos is a German adaptation and uses developmental-psychological theories on the deficits of aggressive children. The units of empathy, impulse control and anger management are taught in 51 lessons. It is taught by trained teachers from Grade 1 (6 years of age) to 3 (8 years of age).

Last updated : 21.03.2019
Country of origin
Germany
Last reviewed:
Age group
0-5 years
6-10 years
11-14 years
Target group
Children aged 5-14 years
Programme setting(s)
School

Be Smart — Don’t Start is a school-based smoking prevention programme intended to prevent the onset of smoking among adolescents. School classes are invited to take part in a competition to remain smoke free for six months. Classes that opt to take part sign a contract indicating their commitment and monitor their smoking on a weekly basis throughout. At the end of the competition, classes that have successfully remained smoke free are entered into a prize draw to win prizes. The competition is based on the self-control and self-management of the pupils.

Keywords
No data
Links to this programme in other registries
No link
Contact details

Dr Reiner Hanewinkel, PhD
Institute for Therapy and Health Research
Harmsstraße 2

24114 Kiel

Germany
Email: hanewinkel@ift-nord.de

Evidence rating
Possibly beneficial
Studies overview

The programme has been evaluated in three cluster randomised controlled trials (RCTs) – two in Germany and one in the Netherlands – and three quasi-experimental studies – one in each of Finland, Germany and Switzerland.

The two German RCTs with young people aged approximately 11-15 years. One study followed participants for up to one year after the competition ended, and the second study assessed participants 18 months after the competition ended. They found no effect on self-reported smoking.

The Dutch RCT, which involved 10-14 year olds, found a statistically significant effect favouring the intervention on the number of self-reported smokers at post-test but not 12-months after the competition ended. There was no effect on self-efficacy or attitudes towards smoking.

The Finnish study, with 14 year olds, found a statistically significant effect favouring the intervention for self-reported onset of smoking (defined as smoking daily) at post-test but not one year later.

The German quasi-experimental study, involving children aged 11-14 years, found statistically significant effects favouring the intervention on self-reported prevalence of smoking at post-test and self-reported daily smoking at post-test and six months later.

The Swiss study involved children aged approximately 13 years and did not find any effect on smoking at post-test.

 

 

References of studies

*Crone, M. R., Reijneveld, S. A., Willemsen, M. C., van Leerdam, F. J. M., Spruijt, R. D. and Hira Sing, R. A. (2003), ‘Prevention of smoking in adolescents with lower education: a school based intervention’, Journal of Epidemiology and Community Health 57, pp. 675-680.

*Isensee, B., Morgenstern, M., Stoolmiller, M., Maruska, K., Sargent, J. D. and Hanewinkel, R. (2012), ‘Effects of the Smokefree Class Competition 1 year after the end of intervention: a cluster randomized controlled trial’, Journal of Epidemiology and Community Health 66, pp. 334-341.

*Schulze, A., Mons, U., Edler, L. and Potschke-Langer, M. (2006), ‘Lack of sustainable prevention effect of the ‘Smoke-Free Class Competition’ on German pupils’, Preventive Medicine 42, pp. 33 39.

*Stucki, S., Kuntsche, E., Archimi, A. and Kuntsche, S. (2014), ‘Does smoking within an individual’s peer group affect intervention effectiveness? An evaluation of the Smoke-Free Class Competition among Swiss adolescents’, Preventive Medicine 65, pp. 52-57.

*Vartiainen, E., Saukko, A., Paavola, M. and Vertio, H. (1996), ‘“No Smoking Class” competitions in Finland: their value in delaying the onset of smoking in adolescence’, Health Promotion International 11, pp. 189-192.

*Wiborg, G. and Hanewinkel, R. (2002), ‘Effectiveness of the “Smoke-Free Class Competition” in delaying the onset of smoking in adolescence’, Preventive Medicine 35, pp. 241-249.

Countries where evaluated
Finland
Germany
Netherlands
Switzerland
Protective factor(s) addressed
Individual and peers: interaction with prosocial peers
Individual and peers: refusal skills and decision making
School and work: rewards and disincentives in school
Risk factor(s) addressed
Community: laws and norms favourable to substance use and antisocial behaviour
Individual and peers: favourable attitude towards alcohol/drug use
Individual and peers: peers alcohol/drug use
Outcomes targeted
Smoking (tobacco)
Description of programme

Be Smart — Don’t Start is a school-based smoking prevention programme intended to prevent the onset of smoking among adolescents. The intervention primarily consists of a competition for school classes to remain smoke free. Although the competition allows some flexibility in terms of the rules followed in a given country, so that details can be altered to suit the needs and circumstances of individual countries, a set of basic principles and rules remains the same:

  • Participation is voluntary, that is, classes decide themselves to participate and to be non- smoking for a period of six months.
  • Pupils sign a class contract and an individual contract promising not to smoke during the competition. The contracts serve to underline their commitment.
  • The competition is based on the self-control and self-management of the pupils, that is, the responsibility for not smoking lies mainly with the pupils themselves: pupils monitor their smoking status and report regularly on whether they have smoked or not.
  • Regular smoking is not accepted.
  • Classes that refrain from smoking for six months are rewarded. They participate in a national prize draw, in which they can win a number of attractive prizes.
  • Participation is free of charge for classes.
 In some countries, classes also receive lessons on smoking, how to quit, how to deal with peer pressure and the strategies of the tobacco industry.

In some countries, classes also receive lessons on smoking, how to quit, how to deal with peer pressure and the strategies of the tobacco industry.

Implementation Experiences
Feedback date
Main obstacles

With respect to individual professionals

Negative attitudes from people about rewarding behaviour which should be normal for adolescents as they are forbidden to smoke by law and negative attitudes towards the fact that the programme was for students starting from 4th grade (people thought this was too early to start and that children would start smoking because the programme would increase their curiosity, etc.).

With respect to organisational and economic context

  • Schools were busy at the beginning of the school year, so they didn’t have time to apply for the programme by the deadline.
  • Incorrect data were received from schools and local programme implementers.
  • Teachers and local implementers tried to add participants during the competition period.

Participants who received no prize at the end of the competition were not happy.

How they overcame the obstacles

With respect to individual professionals

Informing the public about recent studies that show at what a young average age children try smoking for the first time in our country. Explaining that we don’t reward the behaviour, and that, rather, we support and encourage students to stay on the path of non-smoking.

With respect to organisational and economic context

  • We changed the deadlines to give the schools more time to apply for the competition.
  • There was constant follow-up with local implementers to keep the database of participating schools up to date and correct.

Instead of giving out a few big prizes, we divided the resources and awarded smaller prizes, so that more classes had a chance to win. This seemed more reasonable to participants and was more gratifying for them.

Lessons learnt

With respect to individual professionals

Information is the key: inform the parents about the programme, inform the media and provide information on the results.

With respect to organisational and economic context

  • Clear instructions go a long way.
  • You have to have local people who will help to manage the programme at the local level.

Incentives are important for schools and students.

Strengths

Many participants. Local activities in schools campaigning against smoking.

Weaknesses

No control over how many of the ‘non-smokers’ were really not smoking. Not knowing if all the classes that should have dropped out of the programme did so. No supporting activities.

Opportunities

To create different tasks for participants (e.g. a short video in which all the classes show the cool things they do instead of smoking).

Threats

Dishonest participants who win the award and then brag about it. Students who smoke might be bullied by other students because, thanks to them, they all had to drop out of the competition.

Recommendations

With respect to social context

Give enough information about the situation with regard to smoking in your country, and about how parents and teachers can act as role models and support the children when they participate in the programme.

Avoid situations where those who smoke are shamed or bullied by others. Work out a plan for those students who start smoking during the programme period: what should this student do (go to counselling, etc.), what should other students do, what should adults (teachers and parents) do, so that everybody understands that the purpose is to help students become and remain smoke-free, not to shame those who need help.

With respect to organisational and economic context

It is important for the children to show what they are doing during the programme period and also what they have done with the reward money. It is important to give feedback, to encourage everyone and to thank everyone for their support.

Number of implementations
1
Country
Estonia
Last updated : 02.12.2024
Country of origin
USA
Last reviewed:
Age group
11-14 years
Target group
Young people aged 12-14 years and their families
Programme setting(s)
Community
Family
Level(s) of intervention
Selective prevention
Universal prevention

Strengthening Families 10-14 is a seven-session programme for families with young adolescents that aims to strengthen family protection and resilience-building processes and reduce family risk related to adolescent substance abuse and other problem behaviours. The weekly two-hour sessions include separate parent and child skills-building followed by a family session where parents and children practise the skills they have learned independently, work on conflict resolution and communication, and engage in activities to increase family cohesiveness and positive involvement of the child in the family.

Parents are taught how to clarify expectations based on child development norms relating to adolescent substance use, how to use appropriate disciplinary practices, how to manage strong emotions regarding their children and how to communicate effectively. Children are taught refusal skills to help them deal with peer pressure and other skills for personal and social interaction. These sessions are led by three-person teams and include an average of eight families per session.

Keywords
No data
Links to this programme in other registries
USA - Blueprints Programs
UK - CAYT - mentor-adepis
UK - Early Intervention Foundation Guidebook
Germany - Green List Prevention
Poland - Programy Rekomendowane
Spain - Prevención basada en la Evidencia
Contact details

Dr Cathy Hockaday, PhD
Iowa State University
1087 Lebaron Hall
Ames, IA 50011-4380
United States of America
Phone: 1 (515) 294-7601
E-mail: hockaday[a]iastate.edu
Website: www.extension.iastate.edu/sfp

Show link
0
Evidence rating
Unlikely to be beneficial
Studies overview

The Strengthening Families Programme was developed by Karol Kumpfer for children ages 6-11 in the 1990s and is known as the Utah version. Since that time the Utah Strengthening Families Program has been modified for younger children (ages 3-5) and young teens (ages 13-17). Researchers at Iowa State University collaborated to adapt and study SFP for families with early adolescence (SFP for Parents and Youth 10-14), which is known as the Iowa version or SFP 10-14.

The SFP 10-14 version has been evaluated in several randomised controlled trials (RCTs) in Europe in, respectively, Germany (Baldus et al., 2016; Bröning et al., 2017), Poland (Foxcroft et al., 2017), the UK (Moore, 2009; Segrott et al., 2022) and Sweden (Skärstrand et al., 2014; Jalling et al., 2016). Quasi-experimental evaluations were conducted in the UK (Coombes et al., 2012) and Spain (Ballester et al., 2020; Orte et al., 2015). Moreover, the program is cited by one of the developers (Kumpfer et al., 2018) to be implemented in Italy, the Netherlands, Norway, Slovenia, Austria and France.

In the German RCT (Baldus et al., 2016; Bröning et al., 2017), families with a young person aged 12-13 years were eligible to participate. The programme had a booster session 4-6 months later, and assessments were conducted at post-test, six months (i.e. after the booster) and 18 months after the post-test. The primary outcomes were self-reported lifetime tobacco, alcohol and cannabis use at 18 months. Parents and young people also reported behavioural problems. Only the outcome of lower lifetime tobacco use among the SFP 10-14 group compared to the control group was significant. A secondary analysis in this very small sample and relatively young sample indicates that high-risk groups in the SFP-D condition achieved the best results compared with all other groups, especially in mental health and quality of life.

In the Polish RCT (Foxcroft et al., 2017), communities were randomised and families with children aged 10-14 could participate. The primary outcomes were self-reported alcohol, cigarette and other drug use, alcohol use without parent permission, drunkenness and binge drinking in the past 30 days at 12 months and 24 months after baseline. There were no effects on primary outcomes, parenting skills, parent-child relations or child problem behaviour. Foxcroft et al. (2017) state that their null findings may be due to the 24-month follow-up being insufficient to detect positive effects, selection bias resulting from four communities not being randomised to study conditions, a high level of attrition and the fact that one-third of subjects were aged 13-14.

The Swedish cluster RCT study (Skärstrand et al., 2014) involved children aged approximately 12 years and the programme included additional material on alcohol and drugs. It conducted three yearly assessments i.e. mid-programme, post-test and a one-year follow-up. There was no statistically significant effect at any time point on any measure of self-reported smoking, alcohol or drug use. The evaluators contend that the failure to replicate the positive effects found in USA based studies could be due to failure to implement the program with sufficient fidelity, cultural differences or significant alterations to the content of the SFP 10-14.

In the other Swedish RCT (Jalling et al., 2016), at-risk young people aged 12-18 years (indicated by one delinquent behaviour, bullying, repeated conflicts regarding family rules, use of alcohol, tobacco or drugs, or excessive computer use) were randomised to ParentSteps (described as the Swedish shortened version of the Strengthening Families Program 10–14 although it only involves parent sessions), Comet (a programme aiming to help parents develop parenting skills) or a control group. No effects were found for parent-reported problem child behaviour or adolescent-reported anti-social behaviour, delinquency, alcohol or drug use or psychosocial functioning.

The English study (Moore, 2009) involved children aged 10-14 years. Segrott and colleagues (2022) evaluated this adapted UK version (SFP10-14UK, with seven weekly sessions) which brought together families who identified as likely or not likely to experience or present with challenges within a group setting. This pragmatic cluster-randomised controlled effectiveness trial, with families as the unit of randomization (n=715) measured occasions young people reported drinking alcohol in the last 30 days; drunkenness during the same period, and alcohol/tobacco/substance behaviours (age of initiation, frequency, related problems). No statistically significant differences between the two study conditions were observed at the 24-month follow-up on either of the two primary outcomes (previous 30-day alcohol use and having been drunk in the previous 30 days) (Segrott et al., 2022). The authors highlight the importance of evaluating interventions when they are adapted for new settings.

The programme has been rated as Promising by Blueprints for Healthy Youth Development based on a review of studies conducted world-wide.

References of studies

Studies Included in the Assessment Process:

Jalling, C., Bodin, M., Romelsjö, A., Källmén, H., Durbeej, N., & Tengström, A. (2016). Parent programs for reducing adolescent’s antisocial behavior and substance use: a randomized controlled trial. Journal of child and family studies, 25(3), 811-826.

Foxcroft, D. R., Callen, H., Davies, E. L., & Okulicz-Kozaryn, K. (2017). Effectiveness of the Strengthening Families Programme 10-14 in Poland: Cluster randomized controlled trial. European Journal of Public Health, 27, 494–500.        

Foxcroft, D. R., Callen, H., Davies, E. L., & Okulicz-Kozaryn, K. (2017). Effectiveness of the Strengthening Families Programme 10-14 in Poland: Cluster randomized controlled trial. European Journal of Public Health, 27, 494–500.    

 Skärstrand, E., Sundell, K., & Andréasson, S. (2013). Evaluation of a Swedish version of the Strengthening Families Programme. The European Journal of Public Health, 24(4), 578-584.Baldus, C., Thomsen, M., Sack, P. M., Bröning, M., Arnaud, N., Daubmann, A., & Thomasius, R. (2016). Evaluation of a German version of the Strengthening Families Programme 10-14: A randomized controlled trial. European Journal of Public Health, 26, 953–959.    

Segrott, J., Gillespie, D., Lau, M., Holliday, J., Murphy, S., Foxcroft, D., Hood, K., Scourfield, J., Phillips, C., Roberts, Z., Rothwell, H., Hurlow, C., & Moore, L. (2022). Effectiveness of the Strengthening Families Programme in the UK at preventing substance misuse in 10–14 year-olds: a pragmatic randomised controlled trial. BMJ Open, 12(2), e049647. https://doi.org/10.1136/bmjopen-2021-049647

Studies not Included in the Assessment Process:

Ballester, L., Amer, J., Vives, M., March, M. X., & Pozo, R. (2020). Preventing internalizing and externalizing symptoms in adolescents through a short prevention programme: An analysis of the effectiveness of the universal Strengthening Families Program 11-14. Child and Adolescent Social Work Journal, 37, 1–13.
Reason for exclusion: QED, not RCT. 6-month follow-up, positive outcomes on externalising and internalizing behaviour, no substance use outcome

Bröning, S., Baldus, C., Thomsen  M., Sack, P., Arnaud, A., Thomasius, R. (2017). Children with Elevated Psychosocial Risk Load Benefit Most from a Family-Based Preventive Intervention: Exploratory Differential Analyses from the German “Strengthening Families Program 10–14” Adaptation Trial. In Prevention Science (Vol. 18,  932–942)
Reason for exclusion: secondary analysis

Coombes, L. Allen, D. and Foxcroft, D. (2012), ‘An exploratory pilot study of the Strengthening Families programme 10-14 (UK)’, Drugs: Education, Prevention and Policy 19, 387-396.
Reason for exclusion: “Participant recruitment to the study was slow and many families were reluctant to be randomly allocated, instead indicating a preference for the SFP10–14 (UK) group. Rather than abandoning the trial, a decision was made to proceed as a quasi-experimental study, that is, without randomization” (study protocol)    

Kumpfer, K. L., & Magalhães, C. (2018). Strengthening families program: An evidence-based family intervention for parents of high-risk children and adolescents. Journal of Child & Adolescent Substance Abuse, 27(3), 174-179.        
Reason for exclusion: Review paper on contents and research of SFP. Not an effectiveness study. 

Kumpfer, K. L., Xie, J., & O’Driscoll, R. (2012, April). Effectiveness of a culturally adapted strengthening families program 12–16 years for high-risk Irish families. In Child & Youth Care Forum (Vol. 41, No. 2, pp. 173-195). Springer US.
Reason for exclusion: No follow-up (retrospective pre-test), No substance use related outcomes, No analysis of interaction of selection & maturation, Differential baseline differences not controlled for. 

Moore, L. (2009). Project SFP Cymru: Evaluating the impact of the Strengthening Families 10-14 UK Programme on substance misuse. Trial register: https://www.isrctn.com/ISRCTN63550893 

Non-EU studies

Guyll, M., Spoth, R. L., Chao, W., Wicrama, K. A. S. and Russel, D. (2004), ‘Family-focused preventive interventions: evaluating parental risk moderation of substance use trajectories’, Journal of Family Psychology, 18, pp. 293-301.    

Harrison, R. S., Boyle, S. W. and Farley, O. W. (1999), ‘Evaluating the outcomes of family-based intervention for troubled children: a pretest-posttest study’, Research on Social Work Practice 6, pp. 640-655.     

Redmond, C., Spoth, R., Shin, C. and Lepper H. (1999), ‘Modeling long-term parent outcomes of two universal family-focused preventive interventions: one-year follow-up results’, Journal of Consulting and Clinical Psychology 67, pp. 975-984.      

Spoth, R., Redmond, C. and Shin, C. (1998), ‘Direct and indirect latent-variable parenting outcomes of two universal family-focused preventive interventions: extending a public health-oriented research base’, Journal of Consulting and Clinical Psychology 66, pp. 385-399.     

Spoth, R., Redmond, C. and Lepper, H. (1999), ‘Alcohol initiation outcomes of universal family-focused preventive interventions: one- and two-year follow-ups of a controlled study’, Journal of Studies on Alcohol 13, pp. 103-111.

Spoth, R., Reyes, M. L., Redmond, C. and Shin, C. (1999), ‘Assessing a public health approach to delay onset and progression of adolescent substance use: latent transition and loglinear analyses of longitudinal family preventive intervention outcomes,’ Journal of Consulting and Clinical Psychology 67, pp. 619-630.

Spoth, R. L., Redmond, C. and Shin, C. (2000), ‘Reducing adolescents’ aggressive and hostile behaviors’, Archives of Pediatric and Adolescent Medicine 154, pp. 1248-1257.

Spoth, R. L., Redmond, C. and Shin, C. (2001), ‘Randomized trial of brief family interventions for general populations: adolescent substance use outcomes 4 years following baseline’, Journal of Consulting and Clinical Psychology 69, pp. 627-642.

Spoth, R. L., Guyll, M. and Day, S. X. (2002), ‘Universal family-focused interventions in alcohol-use disorder prevention: cost-effectiveness and cost-benefit analyses of two interventions’, Journal of Studies on Alcohol 63, pp. 219-228.

Spoth, R., Guyll, M., Trudeau, L. and Goldberg-Lilehoj, C. (2002), ‘Two studies of proximal outcomes and implementation quality of universal preventive interventions in a community-university collaboration context,’ Journal of Community Psychology 30, pp. 499-518.

Spoth, R. L., Redmond, C., Trudeau, L. and Shin, C. (2002), ‘Longitudinal substance initiation outcomes for a universal preventive intervention combining family and school programmes’, Psychology of Addictive Behaviors 2, pp. 129-134.

Spoth, R., Redmond, C., Shin, C. and Azevedo, K. (2004), ‘Brief family intervention effects on adolescent substance initiation: school-level growth curve analysis 6 years following baseline’, Journal of Consulting and Clinical Psychology 72, pp. 535-542.

Spoth, R. L., Clair, S., Shin, C. and Redmond, C. (2006), ‘Long-term effects of universal preventive interventions on methamphetamine use among adolescents’, Archives of Pediatric Adolescent Medicine 160, pp. 876-882.

Trudeau, L., Spoth, R., Randall, G. K. and Azevedo, K. (2007), ‘Longitudinal effects of a universal family-focused intervention on growth patterns of adolescent internalizing symptoms and polysubstance use: gender comparisons,’ Journal of Youth and Adolescence 36, pp. 725-740.

Spoth, R. L., Trudeau, L., Guyll, M., Shin, C. and Redmond, C. (2009), ‘Universal intervention effects on substance use among young adults mediated by delayed adolescent substance initiation’, Journal of Consulting and Clinical Psychology 77, pp. 620-632.

Spoth, R., Clair, S. and Trudeau, L. (2014), ‘Universal family-focused intervention with young adolescents: effects on health-risking sexual behaviors and STDs among young adults’, Prevention Science 15, pp. 47-58.

Countries where evaluated
Germany
Poland
Sweden
United Kingdom
Protective factor(s) addressed
Family: attachment to and support from parents
Family: opportunities/rewards for prosocial involvement with parents
Family: parent social support
Individual and peers: refusal skills and decision making
Individual and peers: skills for social interaction
Risk factor(s) addressed
Family: family conflict
Family: family management problems
Family: neglectful parenting
Family: parental attitudes favourable to alcohol/drug use
Individual and peers: early initiation of drug/alcohol use
Individual and peers: favourable attitude towards alcohol/drug use
Individual and peers: favourable attitudes towards anti-social behaviour
Individual and peers: interaction with antisocial peers
Outcomes targeted
Academic performance
Depression or anxiety
Other mental health outcomes
Relations with parents
Alcohol use
Use of illicit drugs
Smoking (tobacco)
Other behaviour outcomes
Description of programme

The seven-session programme for families with young adolescents is based on the biopsychosocial model and aims to strengthen family protection and resilience-building processes and reduce family risk. Sessions are conducted once weekly for seven weeks. The first six sessions last two hours, consisting of one hour of separate parent and child skills-building followed by a one-hour family session where parents and children practise the skills they have learned independently, work on conflict resolution and communication, and engage in activities to increase family cohesiveness and positive involvement of the child in the family. The final session is a one-hour family interaction session without the concurrent parent and child training sessions.

Parents are taught means of clarifying expectations based on child development norms relating to adolescent substance use, how to use appropriate disciplinary practices, how to manage strong emotions regarding their children and how to communicate effectively. Essential programme content for the parent skills training sessions is contained on videotapes that include family interactions illustrating key concepts. Children are taught refusal skills to help them deal with peer pressure and other skills for personal and social interaction. During the family sessions, family members practise conflict resolution and communication skills and engage in activities designed to increase family cohesiveness and the positive involvement of the child in the family. These sessions are led by three-person teams and include an average of eight families per session. The length of the intervention may depend on where it is delivered, that is, in a school, in a group or at home. The programme is delivered by certified group leaders, site coordinators or supervisors.

The Strengthening Families Programme was developed by Karol Kumpfer for children ages 6-11 in the 90ies and is known as the Utah version. Since that time the Utah Strengthening Families Program has been modified for younger children (ages 3-5) and young teens (ages 13-17).

Researchers at Iowa State University collaborated to adapt and study SFP for families with early adolescents (SFP for Parents and Youth 10-14), which is known at the Iowa version or SFP 10-14.

Intervention variation

In Sweden, a version of the Strengthening Families 10-14 programme adapted to Swedish conditions, including through some modifications to the programme format agreed with the programme’s developer, is implemented. The Swedish version consists of two parts. Part one comprises seven sessions, delivered over seven consecutive weeks in grade 6 (12 years of age); there are six separate sessions for children and their parents, with one joint family session. Part two comprises five sessions, delivered over five consecutive weeks in grade 7 (13 years of age); there are four separate sessions for children and their parents, with one joint family session. This differs from the original programme, where each weekly session includes a separate hour for parent and child, and then one hour with parents and children together.

The programme content is similar to the original Strengthening Families 10-14 programme to a large extent, although some family session topics are omitted due to the change in format/delivery. Whereas the original programme is held in community centres with parent and child sessions run at the same time, for practical reasons, the child sessions in the Swedish version are run during school hours and parent sessions are run separately in the evening, so ‘some family components were lost’. Youth sessions are conducted by class teachers, with the assistance of a group leader. Group leaders conduct parent sessions. All group leaders are trained by certified Strengthening Families 10-14 trainers. The Swedish version also includes some new material in part two, designed to enhance the alcohol and drug content.

Implementation Experiences
Feedback date
Contact details

Cátia Magalhães
catiacmagalhaes[a]gmail.com
 

Main obstacles

With respect to individual professionals

- Recruitment of families when an agency or school start up is always difficult until there is positive word of mouth and agency staff buy-in to get referrals.
- Select and implement and evidence-based programme instead of other programmes that are on offer.

With respect to social context

Once in a while, the resistance to adopting EBPs from other countries arises because of the perceived difficulties in adapting them to new cultures or new situations.
- Initially the weeks of the programme and the number of sessions.

With respect to organisational and economic context

- Financial issues (raise the funds from local foundations and agencies).
- Selecting and implementing EBPs instead of other programmes that are on offer (and can be shorter and less expensive, although with less positive results).

How they overcame the obstacles

With respect to individual professionals

- Called and talked with families and targeted schools.
- Talked with people from the representative agencies of the targeted populations.
- Spread and disseminated EBPs and practices through professionals.

With respect to social context

- Adapt the programme to the unique needs and situational/social context while preserving the programme´s core content.
- Overcome barriers to programme implementation and implement strategies to increase recruitment and retention.

With respect to organisational and economic context

- Spread and disseminate evidence-based programmes and practices through local agencies and local government.
- Cost-effectiveness of EBPs compared with non-EBPs and practices.
- Explain risk and protective factors of the context.

Lessons learnt

With respect to individual professionals

- It is important to select, train and supervise staff (group leader or facilitator) to assure quality implementation.
- Supervision from programme implementer or national/local coordinator.
- Cultural adaptations are needed to maintain fidelity to the original programme.

With respect to social context

- Parents and families want universal family values. So it’s important to become familiar with the targeted population’s cultural values, priorities and characteristics.
- We can adopt EBPs from other countries and have similar positive and significant results.

Strengths

- The programme is durable and has large positive outcomes in its first implementation in Portugal, like in other several countries.
-The material and format are easy to use.
- Sensitivity towards language barriers and cultural factors.
- Topics and session contents.
- Three groups/moments: parents, children and family (parents and children together).

Weaknesses

- Group version is staff-intensive and costly.

Opportunities

- Having existing paid staff or volunteers from the community to implement the programme can help to reduce the staff costs.
- Working with local agencies and government services (e.g. social services, children protection commissions).

Threats

- Financial issues (taking into account economic, national and local context).

Recommendations

With respect to individual professionals

- Good staff selection and training/supervision.
- Training staff in EBPs and core components of the programme.
- Ethnically and linguistically matched to the target population.

With respect to social context

- Disseminate the results and effectiveness of the programme.
- Carefully identify the most pressing problems/risks and protective conditions (helps to guarantee better outcomes).
- Include cultural adaptation of the programme.

With respect to organisational and economic context

- Disseminate the results and effectiveness of the programme.
- Cost-effectiveness studies.
- Develop practical collaborations between practitioners, clients, policymakers, researchers, etc. to improve programme implementation and dissemination.

Number of implementations
1
Country
Portugal
Feedback date
Contact details

Joan Amer
joan.amer[a]uib.es
 

Main obstacles

With respect to individual professionals

Lack of training and need of understanding of the theory of change of the programme. Temporary jobs, which mean lack of stability: changes in professionals from one application to other.

With respect to social context

Need of network and social support within neighbourhoods. Need of cooperation between social services and educational services.
Seasonal job market. Lack of bond with communities, due to unstable housing.

With respect to organisational and economic context

  1. Eventually, in some applications, specific support had to be implemented for some children who disrupted the functioning of the sessions.
  2. In other cases, the protocol had to be implemented in order to exclude some participants that fullfilled the requirements of exclusion criteria. This is the case of some children with active antisocial behaviour. This rarely happened and it was because these children were not detected at the selection process prior to the programme.
How they overcame the obstacles

With respect to individual professionals

Improvement of the system of selection of professionals, better connections with those NGOs with competent and experimented professionals.
Increase and improvement of training: further hours of training, more dedication to emotional techniques and roleplaying.

With respect to social context

Better networking with professionals in the communities: preparatory sessions, linking and bonding with relevant educational professionals.
Utilisation of social networks (web etc.) for improving communication.

With respect to organisational and economic context

  1. Once the specific educational needs were identified, the implementation team (educators, coordinator and members of our research group) would decide the type of adapations of the programme.
  2. Principally, specific support to the child would be implemented (sometimes with the participation of some collaborator from the university).
  3. Different strategies were also prepared for the child to make sure that she or he acquires the essential contents and participates as much as possible in the dynamics of the group.
Lessons learnt

With respect to individual professionals

The importance of experienced professionals, but also of availability for learning and adherence to the programme.

With respect to social context

The counterpart: social service, school and/or NGO that you are working with is critical for the quality of the implementation.

With respect to organisational and economic context

The opportunity to implement a standardised academic programme with elements of community and family intervention.

Strengths
  1. Taking into account the results and the evaluation of the Spanish programme, we are able to state that SFP can be successfully adopted without compromising effectiveness. Our results suggest that the validated programme for the Spanish population (PCF) accomplishes its objectives and is valid for positively modifying protection and risk factors. Furthermore, effectiveness of the culturally adapted programme is tested in parents, children and families. Training for parents increases their parenting skills; training for children enhances their social capacities and personal development; and family training improves both positive relations at home and parental implication.
  2. This programme addresses issues that an "insider" or "autochthonous" (using the terms of the questionnaire) may not have considered. Different aspects are incorporated. External perspective offers new ideas and proposals.
  3. The allochthonous component of the programme makes the results more valuable. It is feasible to implement succesfully a programme of these characteristics: results of the applications in the Spanish adaptation are consistent with those obtained by SFP in reference applications (Kumpfer, 2003; Kumpfer et al., 2008), demonstrating its effectiveness.
  4. Spanish adaptation of the programme (PCF) has demonstrated that the programme is valid to work with populations that are socially and culturally different. Results of this adaptation demonstrate that the programme is able to be effective both in Spain and internationally.
  5. Overall evaluation is positive. We are satisfied with the results. Last, we specially appreciate and highlight the innovative component of the programme within family intervention
  6. The protocol has been implemented without major or significant difficulties. In the case of families with uncovered basic needs, we had the support of professionals from social services. These professonials also monitored the demands of those families.
Weaknesses

Previous to the implementation of the programme, aspects such as physical punishment were not included in the Spanish adaptation.

Opportunities
  1. It is important to share the specific experiences, implementations and outcomes in different countries and settings in order to exchange experience and improve/polish the programme. In this sense, initiatives such as this questionnaire are very useful.
  2. Adaptations were made taking into account both the curriculum and the objectives of the programme. Adaptations implied modifications of formal aspects such as language and the presentation of resources. New activities and proposals were introduced to facilitate the performance of the sessions. Also incentives for children were revised.
  3. Context adaptation consisted mostly of modifications in language aspects, teaching proposals, games, illustrations, songs.
  4. Recent restrictive legislation on tobacco has had an important impact on levels of consumption.
  5. Advertising of alcohol (allowed) — even though legislation is becoming more restrictive.
Threats
  1. The Balearic Islands are an important mass tourism destination in Western Europe. Different implementations of the programme have been executed in coastal populations with high risk levels of social exclusion. Social exclusion in tourist resorts is principally due to the characteristics of the labour force in the tourism sector in the Balearic Islands: it is an unskilled, seasonal, intensive and low-wage workforce.
  2. In the case of our applications in the Balearics, seasonality of the tourist economy impacts in the scheduling of the programme. Parents can have serious difficulties attending the sessions during peak tourist season.
  3. The Balearic Islands have the highest rate of school drop out in Spain, greater than the average of the European Union.
  4. Age restrictions for going out — there is a permissive culture. The phenomenon of "Botellón": outdoor alcohol drinking.
  5. Negative attitudes towards illicit drug users — stereotypes or social prejudice can arise. It is frequently associated with crime.
Recommendations

With respect to individual professionals

Proper selection of trainers, and proper training. Training with both a theoretical background but also a practical focus (emotional techniques, leading group skills, roleplaying, etc.).

With respect to social context

It is important, first, to be aware of the level of cultural adaptation needed in each country or context and, second, to make use of the evaluation as a tool for permanent improvement of the programme.

With respect to organisational and economic context

  1. Organisational culture of the institution where the implementation takes place is important.
  2. Regarding economic context, characteristics of jobs of parents influence the level of participation. In our case, seasonal and unskilled jobs are predominant. Also the environment for adolescents is relevant. In the case of the Balearic Islands (Spain), there is easy acces to the job market (abandoning school) and a high presence in the resorts of leisure lifestyles with drug abuse due to the type of tourism.
Note from the authors

Family Competence Program (Spanish SFP)
PCF7-12 (Spanish adaptation of SFP6-11);  2015 on the PCF12-16 (adaptation)  

Number of implementations
1
Country
Spain
Feedback date
Contact details

Robert O'Driscoll
robert.odriscoll[a]hse.ie

Main obstacles

With respect to individual professionals

Staffing.

With respect to social context

The need to make sure that a needs assessment was conducted in the communities where the programme was intended to be implemented.

With respect to organisational and economic context

A lack of consistent organisational support.

How they overcame the obstacles

With respect to individual professionals

We developed an interagency implementation model. The key stakeholders included the Health Service Executive, local and regional drugs and alcohol task forces, the Child and Family Agency (TUSLA), the Gardaí (Community Policing) and Young Person’s Probation.

With respect to social context

Consulted with local service providers, who in turn consulted with service users around the need for and their willingness to participate in the SFP.

With respect to organisational and economic context

Sometimes sheer determination was required to overcome the lack of support from senior management and administrators.

Lessons learnt

With respect to individual professionals

The important lessons learnt were multi-level. Funding and management support were necessary at all levels; well-trained staff and facilities committed to the programme implementation and sustainment were needed. Including the families as much as possible in the planning, implementation and evaluation of programmes was necessary. It is important to create a space within the implementation infrastructure and architecture for the implementers to come together and work through the tensions and dilemmas that are likely to arise throughout the implementation process, so that the problems do not become embedded or become obstacles to the implementation process. Having well-qualified coordinators to guide the implementation process and to ensure programme fidelity and support the programme team was important.

With respect to social context

  • Implementing an evidence-based programme requires a well thought out implementation plan with commitment from all major stakeholders. It was interesting to see the competition among stakeholders for recognition of individual and agency-level commitments and the political climate that a successful implementation can create. It is worth noting that each agency wants to be recognised and associated with a successful programme, sometimes above and beyond the level of commitment they may have given to the implementation process, and very few want to work on or be associated with working through the problems that arise during the implementation.
  • An implementation team needs to be created around the SFP so that experience can accumulate over time.

With respect to organisational and economic context

A successful and sustained implementation of SFP requires a local “Champion” to promote the programme within and outside the organisational context. Programmes must be evaluated and the findings shared within the wider network of service providers, regionally at least and nationally if possible. The evidence will support the future sustainability of the programme in terms of funding and political support and contribute to an accumulating evidence base for the programme. An alliance with the programme developer can help to overcome organisational obstacles to the successful implementation of SFP.

Strengths

The evidence base for the programme is the strength of SFP.

Weaknesses

The resource-intensive nature of the programme.

Opportunities

The interagency model of service delivery can be used for other types of programme implementation but also contributes to the development of a strong network of distributed expertise that can be harnessed on behalf of vulnerable service users.

Threats

The political environment that can accrue around an evidence-based programme like SFP. Administrators and funders trying to implement a programme without the necessary knowledge and skills around the nuances of practice.

Recommendations

With respect to individual professionals

Make every effort to train staff well in the programme and to ensure that they have the requisite skills to work with families individually and in a group setting. To make evidence-based programmes like SFP part of the undergraduate curriculum.

With respect to social context

Undertake a needs analysis of the communities where SFP is intended to be implemented to make sure it is the correct fit for the local context.

With respect to organisational and economic context

Ensure adequate funding by evaluating programmes and publishing the results. Keeping administrative and funding support out of the practice environment while balancing the need for ongoing management support to sustain the programme with fidelity over time.

Number of implementations
1
Country
Ireland
Feedback date
Main obstacles

With respect to individual professionals

We implemented the RCT in 19 schools in Stockholm. The main obstacle was recruiting leaders to the programme to deliver both the children’s sessions, the parents’ sessions and the family sessions. We were planning to train teachers to deliver the children’s sessions, but they were not allowed to work extra hours during the evenings for the parents’ and family sessions.

With respect to social context

Recruiting schools, as this was an RCT and schools were randomly allocated to the programme and control groups.

With respect to organisational and economic context

Since this was a study, we had a limited budget.

How they overcame the obstacles

With respect to individual professionals

We resolved that obstacle by training retired schoolteachers to be in charge of the parents’ sessions in the evenings (on the same day that their children had their sessions). The retired schoolteachers also took part in the children’s sessions during the day, so they could make links between the children’s and parents’ sessions. We also changed the original programme format, in that we only had two family sessions in order to make it possible for children and parents to be together in the evening.

With respect to social context

We offered the control schools the chance to implement the programme after the study was over.

With respect to organisational and economic context

We had to make some alterations to the programme format and limit the family sessions.

Lessons learnt

With respect to individual professionals

It is hard to balance cultural adaptation and programme fidelity.

With respect to social context

Go out in person to the schools and talk about the study and the importance of taking part.

Strengths

The Swedish version does not differ significantly from the SFP 10-14 in terms of content. All the core components, like communication skills, family bonding, peer resistance skills, stress management, handling emotions, and communicating rules and consequences in relation to household chores, as well as expectations concerning substance use, are intact. Even though some of the family session components were omitted, we tried to make up for this by introducing links between the children’s and parents’sessions, and by adding extra weight to the content of the two existing family sessions.

Weaknesses

We were not able to hold all the family sessions.

Threats

It is not an easy task to adapt intervention programmes from one context or country to another. You must be able to culturally adapt the programme without losing the core components.

Note from the authors

Steg-för-Steg - a Swedish version of the Strengthening Families Program 10-14 (SFP 10-14)

Number of implementations
1
Country
Sweden
Feedback date
Main obstacles

With respect to individual professionals

  • Dominant practices to help parents are group discussions under the supervision of psychologists. Evidence-based educational and manualised programmes are not used.
  • Multiplicity of actors and actions
  • Heterogeneity and low level of training for family support professionals
  • Inexperience and reluctance to implement educational programmes for parents
  • No culture of scientific evaluation
  • Reluctance in relation to the project itself, in particular the commitment of families over time (14 weeks)

With respect to social context

  • Multiplicity of actors to inform and convince
  • Astonishment to see support for parenthood in the field of health
  • Frequent opposition in principle by the professionals involved in traditional forms of support to parenthood (standardised programme, Anglo-Saxon programme, caricature of behaviouralism)
  • Difficulties in choosing families: risk of touching "those who do not need it"

With respect to organisational and economic context

  • Municipal doubts during the first implementation of the programme:
    • Fear f not having qualified staff to play the role of facilitator
    • Financial cst (average announced = 15,000 euros for year 1)
      • appointment of a municipal coordinator of the programme plus four facilitators
      • funding of their working hours, training and facilitation of the 14 sessions
      • logistics: organisation of information meetings, provision of rooms adapted for the training and animation of the sessions
  • Low external "visibility" of the project for elected representatives (few families, unlike the "conference" mode)
How they overcame the obstacles

With respect to individual professionals

  • Slow progress of implementation on each site
  • On each site of implementation:
    • Several meetings setting up detailed infrmation about the programme: origin, concepts, principles, philosophy and ethics, results
    • Systematic invitatin of professionals involved in supporting families at our meetings
    • Distributing infrmation to the largest possible number of professionals from various fields (social, education, sport, culture) in contact with families
  • Positioning of the programme in the educational field, in complementarity with other parenting support actions
  • Presentation of the work done for SFP's cultural adaptation
  • Reinforcement of the training of those responsible for the programme’s implementation (at the theoretical level and at the level of action) highlighting the programme’s philosophy and its ethics

With respect to social context

  • Enthusiasm and perseverance
  • Clear and explicit, intense and diversified communications with elected representatives, funders, professionals and parents
  • Involvement and appreciation of local partners in reflection and implementation
  • Identification of cities as privileged partners in the implementation, valuing the benefits to them, in terms of training their teams
  • Targeting living areas of low income families

With respect to organisational and economic context

  • For the first implementations of PSFP in France:
  • Natinal funding
  • Supprt of decentralised departmental services: prefecture, social cohesion, city policy
  • Inclusion or support of PSFP to a device already in place: city health workshop, local education plan
  • Enthusiasm of professionals during the discovery of the programme
  • Interest, enthusiasm and satisfaction of parents
  • Interest of the elected officials
Lessons learnt

With respect to individual professionals

  • Interest in and necessity of a long phase of presentation and explanations to the greatest possible number of professionals on each site of implementation
  • Interest in and need to broaden the base of the professionals concerned; mobilisation of professionals in contact with families, not just those already involved in parenting support
  • Interest in and need for strengthening training, both in its content and in the number of people benefiting from it
  • Added value of the implementation and training process:
    • Individual: strengthening the prfessional skills in parenting support
    • Collective: better mutual knowledge and articulation between the professionals on each side

With respect to social context

  • Relevance of the association with the cities, recognized as a strong local partner, identified in the diversified support for families (social, educational, prevention, culture, sports, leisure) and already working in a network
  • Give incentives to cities (elected policy makers and local professionals) for the implementation and management of the programme
  • Need to obtain a commitment from elected representatives through a partnership agreement

With respect to organisational and economic context

  • Adaptation to the context and searching for local support are essential
  • Support from the cities in their search for funding
Strengths
  • The programme itself:
    • Its cncrete and experiential aspect for parents
    • The assciation of 3 time periods: parents / children / families
    • Quick enthusiasm frm trained professionals and parents
    • The ethics f facilitation
    • Orientation to parenting skills, mental health promotion
Weaknesses
  • Heaviness of initial investment, especially financial
Opportunities
  • Expansion of programme’s positioning
    • In the fight against the misuse f screen time
    • In the fight against social inequalities in health
Threats
  • Enough rigour to keep the programme in its original form, in 14 sessions and 3 time-periods (parents / children / families) and avoid losing fidelity
  • Enough perseverance in the training of professionals who develop and facilitate
Recommendations

With respect to individual professionals

  • Involve local professionals in setting up the programme
  • Analyse the training needs of developers and professionals
  • To be attentive to ethics of the facilitation of a programme that values parents
  • Strengthen training

With respect to social context

  • Analyse the appropriateness of the programme to local standards of support for parenting
  • Carefully choose target audiences
  • Broaden the objectives of the programme in the fight against the abuse of screens

With respect to organisational and economic context

  • Rely on existing partners or networks
  • Provide funding
Note from the authors

Programme de Soutien aux Familles et à la Parentalité 6-11 ans - French adaptation of the Strengthening Families Program

Number of implementations
1
Country
France
Feedback date
Contact details

Dina Kyritsi (Psychologist, MA, MBPsS)

dina_kyritsi[a]yahoo.gr

Main obstacles

With respect to individual professionals

Competition between the facilitators, especially in the youth sessions (which are delivered by two professionals  ), was an issue that we tried to overcome. Not all our facilitators had attended the same training course and most of them had never worked together as a team. The Strengthening Families Programme SFP10-14 presupposes good chemistry between the three facilitators who are responsible for a given group of families. In addition, it was important for the programme’s facilitators to always come very well prepared for the sessions. Their initial training was not enough, without investing personal time in preparing and practising for the sessions.  Cultural accommodation of the SFP10-14 for Greece provided strong grounds to warrant a pre-implementation stage in future planning, wherein all the facilitators meet and go through every activity of the sessions together to ensure a uniform understanding of its function and purpose within the session.  It is hard to evaluate how well the SFP10-14 was implemented in every group or the variation in the implementation between different groups. The post-implementation interview data could possibly point to weaknesses in the programme itself or how well the programme was executed. At the moment, there is no standardised tool to measure how well the sessions were delivered (external observers or a self-evaluation by the facilitators themselves could perhaps have served this purpose).  

With respect to social context

It was hard for our participants to follow the English-language DVDs with Greek subtitles that we utilised during the first implementation of the programme (we ended up reshooting the DVDs with Greek actors). In several vignettes (e.g., the shoplifting vignette), the responses of parents in the video were much milder than what would be ‘natural’ for a Greek parent, which made the DVD families ‘too good to be true’ in our participants’ eyes. It was hard to find something equivalent to replace such scenes, as this would have required rewriting the script, without having the option to consult or obtain permission from the programme’s US authors. Using ‘chores’ as a behaviour management tool was another core concept of the US programme that we found hard to intregrate into Greek family practice, as assisting with the household chores is usually not a highly valued behaviour in Greece for an adolescent pupil (frequently not even by his or her parents, who would prefer that he or she studies instead).
As regards the general social context, the parents were reluctant at some points to consider the methods proposed by the programme; they felt that they were somehow ‘American’ and they would be realistically hard to implement with their youth. In addition, several parameters related to background work for the implementation were very different from the US. For example, fortunately volunteerism is still common in the US, whereas in Greece - especially after our deep economic recession - there is no place for volunteerism, as everybody is striving to make ends meet. We had to consider not only the SFP10-14 families, but also our facilitators, who often had to leave their own, young children unsupervised, in order to undertake unpaid work for the programme.

With respect to organisational and economic context

It was hard to obtain license from the Greek Ministry of Education to access public schools, in order to inform parents and young people about the programme and recruit participants. Our country is not very open to innovative healthcare initiatives that are not centrally organised by the state.
Furthermore, as already argued, much of the facilitators’ work went beyond the SFP10-14 sessions. A flexible financial planning was able to account for the extra work that typically arises at the stage of adaptation (e.g., private, one-to-one time with the families who faced special challenges, identified when special needs came up during the sessions, or feedback from the facilitators, such as the observation diaries that they were asked to complete following each session). The financial demands are quite different between countries in which the SFP10-14 has been implemented for years and is running smoothly and countries in which the programme is being first introduced, such as Greece.

How they overcame the obstacles

With respect to individual professionals

An effort was made to build positive relations, empathy and team spirit within the Greek SFP10-14 team and to ensure the best match between the facilitators and our groups of families. In addition, we prepared plans and small maps for the facilitators’ use, as ‘personal assistants’, and we organised the various materials that the facilitators would need to use during each session. The Greek SFP10-14 manual has also included helpful tips proposed by the facilitators who had already delivered the programme in Greece.

With respect to social context

We reshot the DVDs using much simpler language. We replaced specific activities and chores that were considered ‘too American’ (e.g., billiards, bowling, gardening, cleaning the basement etc.) with more plausible alternatives. We replaced a few scenes that seemed ‘unnatural’ (e.g., the parents’ response to shoplifting). We also made sure that our DVDs did not include families of ethnicities that rarely immigrate to Greece (e.g., no coloured families were included, as in the UK DVD set; the Greek video portays an immigrant family of Filipino descent instead).
In addition, the adaptation of the DVDs has had to account to an extent for the difference in parenting values. It also required skilful handling on the part of the facilitators, who often anticipated the families’ concerns or opposition, before they were explicitly expressed in the group by the families.

With respect to organisational and economic context

We made every effort to highlight the affiliation of the US SFP10-14 with the Agia Sophia Hospital for Children, which is a University Clinic and the largest paediatric hospital in Greece and has formed for years the official basis of the Greek programme. This affiliation added weight to our endeavour in the eyes of officials in the Ministry of Education and the School Division of the Municipality of Athens as well as in the eyes of the participant families.
As to the financial demands, volunteer work was additionally required, in order to overcome financial shortage.
 

Lessons learnt

With respect to individual professionals

Our practice pointed to the need for supervision and evaluation of the programme’s facilitators, not only of the programme. Given that the pool of certified facilitators in Greece is necessarily limited (as very few training sessions have been offered), there were not many alternatives in case that something did not work out as planned. As with every project, tasks and deliverables need to be extremely clear right from the start (which is not easy when adapting an allochthonous programme, where several things may come up that were not prescribed, creating tension when several deliverables are not predicted from the outset).  

With respect to social context

It is important not to get carried away with the original material and to make sure that you test every  adaptation of the original material on several samples from the target population in advance, so as to ensure that all parts of the programme are meaningful in terms of language and cultural norms. When implementing an allochthonous programme  , you need to be faithful yet creative.

With respect to organisational and economic context

The programme’s protocol should explicitly allow time for the work required outside the sessions, instead of focusing on session delivery only. Especially in Greece where the SFP10-14 has not received any backing from the national health system or well-established agencies (which have supported the program in the US and the UK), project planning should allow time, space and a budget for the introduction, familiarisation, promotion and dissemination of the programme, rather than implementation only.

Strengths

1)    The SFP10-14 can be adapted successfully to other contexts (wider community/society, multiple settings) without compromising effectiveness.
2)    An allochtonous programme draws on the scientific advances of a different country. Most programmes produced in the same cultural context draw on a similar pool of resources and are based on the same mentality, the same ‘air’, the same dead ends. An allocthonous programme can bring a very refreshing innovation with a different perspective, which therefore prevents it from encountering the same, old dead ends. In addition, the Greeks generally trust scientifically based and tested allocthonous interventions (at least healthcare initiatives from North America and the UK).
3)    Therefore, it is feasible to successfully implement an allochthonous programme without compromising effectiveness.
4)    All parts of the US protocol were effective and continued to play their part; surprisingly, even the slogans (i.e, the SFP10-14 creeds or mottos), which are not common in Greece (except in advertisements) and thus would not normally be expected to work well in the context of a healthcare programme.
The US SFP10-14 addresses a very diverse socioeconomic and structural context. As long as you maintain this feauture, the programme will remain effective. For example, the home of a poor family in Greece may be different from the home of a poor family in the US, but the DVDs for both countries explicitly include both affluent and less affluent households, so that a Greek family of low socioeconomic status would also feel included.

Weaknesses

1)    Assessment of the effects of the SFP10-14 should not focus on prevention only. The budget for any cultural accommodation of the SFP10-14 in Europe was offered by the alcohol industry, perhaps with the effect that assessment focused heavily on alcohol prevention. Our implementation suggested that the true potential of the programme is highlighted only, when measures of family well-being are introduced. It is the Strengthening Families Program, after all! Our results (obtained from a battery of valid tests coupled with participant interviews) suggest that the programme did make a significant difference to the families’ lives (in terms of communication, conflict resolution, quality time together etc.), although we obtained non-significant results for most alcohol-related measures. A question of course would be how long after implementation do we measure the programme’s effectiveness as prevention (only longitudinal research could achieve this with validity) and also how can one measure effects in prevention, when the majority of the adolescent participants have zero contact with alcohol or drugs as a starting point during the sessions (floor effects are to be expected…). When an allochthonous programme is introduced, it is only natural that you have to adapt not only the programme, but also the allochthonous assessment, which usually depends on the funding resources of a foreign country and thus may obscure the true potential of the specific programme in your own country.
2)    10-14 does not necessarily correspond to the same age range across cultures. In several cases, our Greek participant parents reacted negatively, when the sessions made reference to drug use (e.g., the mention of ‘cannabis’), as they felt that their adolescents were too young to know about drugs. The SFP10-14 probably encompasses two quite different age groups already, with quite different challenges and needs.

Opportunities

1)    There is a fine line between being faithful to the original programme and coming up with materials that are too ideal for the country’s reality and are therefore perceived as artificial. It is important that the participants feel as if the programme were written exclusively for them, rather than as if they are being pushed towards believing that the programme is relevant to their own lives. In practice, things that seem awkward need to be replaced (even if 3 in a sample of 10 say that they are OK), rather than having the facilitators try to persuade the participants that they are OK, because the original programme includes them. The SFP is effective, only if the participants feel that it is.
2)    All references to non-relevant cultural context were omitted and replaced with their nearest, culturally appropriate equivalent. As an example, nobody gets a driving licence in Greece before the age of 18. Therefore, the mother’s anxiety in the video that her teenage son might drive drunk was replaced by anxiety that the boy might get into the car of an older friend who drinks and drives, or anxiety that he might get into a stranger’s car, when invited to do so, because of alcohol that is impeding his judgement. All such alterations were based on common sense, testing, feedback from the SFP10-14 pilot participants, survey feedback from an independent advisory group (our ‘panel of experts’) and data gathered from all our facilitators, who recorded their own subjective experience in delivering each session.
3)    We adjusted the time allocated to each activity during the SFP10-14 sessions, depending on the participants’ ability to follow as well as the relative weight of each activity. All our facilitators found it impossible to follow the rigid US time plan.
4)    As an exception, we allowed younger siblings (below 10 years) to attend, if a family really wanted to attend, but had nowhere to leave their younger child (We could not afford day care for the younger siblings’ during our sessions, as the US programme did).
5)    Finally, we provided extra services to several participant families for free, which was not included in the programme’s protocol. All the participant parents asked for some private counselling time, some feedback about special issues that the facilitators might have identified in relation to their child or their family during the sessions as well as feedback about their test results. Our team of psychologists did give them this extra time, but focused on remaining facilitators rather than family therapists. We also referred families to external services (e.g., the Municipality, public hospitals etc.), where they could continue receiving support after the programme, depending on the nature of their needs. We made use of our professional status, in order to intervene and ensure that they booked an appointment quickly, when it was hard for them to do so on their own. We helped a few families become eligible for discounts in specific supermarkets in the city. All the above were not included in the SFP protocol, but professional responsibility and human concern did not allow leaving individual families without any support, after they completed the programme.
 

Threats

By nature, the SFP10-14 targets a variety of heterogeneous domains and has a variety of objectives. A real threat to the programme would be to split it into parts, with each part being used independently. In this way, apart from unity, the programme would lose its validity and effectiveness. We witnessed such an attempt, when official agencies of status that work with addiction in Greece expressed their interest in showing the videos for sessions 5 and 6 only (i.e., the DVDs that focus on addiction) to the families of young people with addictions. Other professionals expressed a wish to use only the SFP10-14 tools and materials that specifically address stress and coping, etc. The possibility that the programme could be split into pieces in this way is still a big threat, as there is no centralised supervision at the moment and the holder of the original copyright is so far away from Greece (in kilometres).

Recommendations

With respect to individual professionals

It is crucial that the facilitators are higly motivated and very well prepared for each session that they deliver. The sessions entail much more than executing the instructions of the SFP10-14 manual (which nevertheless need to be very simple and explicit, so that the sessions are implemented in a uniform manner).

With respect to social context

1)    Implementation requires envisaging the actual practice of the sessions, deciding which activities you could save time from (i.e., time management — more than the ‘optional activities’ of the manual) and anticipating possible resistance from parents to the parts that feel too foreign to them. How will you defend the cultural appropriateness of your SFP?
2)    A group with a lot of children in the younger age range (10-12 years) will probably be more challenging, making it harder to fulfil the session targets. Youth sessions need to carefully invite a relatively uniform, in terms of age, group of pupils.

With respect to organisational and economic context

1)    The SFP10-14 utilises a pool of very impressive materials and posters, which, however, need to be covered very quickly in the sessions, due to time constraints. In practice, this might prove impossible, when the participants are not fluent readers (as in the case of our participant immigrant parents). You may need to sacrifice aesthetic quality, in order to maximise comprehension (colours, typeface, language) and to minimize the related costs of course.

2)    Finally, there has to be a uniform policy about how to handle very personal or ‘touchy’ issues that might be disclosed during the sessions, as the participants gradually open up. For example, at family session 6 (when all our parents were certain that their children were too young to know about drugs and a few even asked the facilitators to refrain from talking about drugs, because ‘the kids are still innocent’), a 10-year-old boy disclosed in front of the group that he had smoked hashish  at school. The boy was really innocent: he did not realise the significance of what he was saying. How do you handle this? Implementation needs to include a uniform policy about such issues, to be followed by all faciliators for the benefit of the programme.

Note from the authors

Strengthening Families Program, SFP10-14

Implemented in Athens between 2009-2013

Number of implementations
1
Country
Greece
Last updated : 07.05.2019
Country of origin
Germany
Last reviewed:
Age group
11-14 years
15-18/19 years
Target group
School children aged 12-15 years
Programme setting(s)
Family
School

Aktion Glasklar is a school-based programme delivered to secondary school students with the aim of preventing them from consuming alcohol. Teachers deliver four sessions over a three-month period, as well as circulating educational brochures about alcohol to both parents and students. The four units aim to educate students about alcohol use and cover the topics of what is actually permitted, advertising, temptation and when drinking alcohol may be OK.

Keywords
No data
Links to this programme in other registries
Germany - Green List Prevention
Contact details

Professor Dr Reiner Hanewinkel, PhD
Institute for Therapy and Health Research
IFT-Nord, Harmsstr. 2

Kiel, Schleswig-Holstein 19716
Germany
Email: hanewinkel[a]ift-nord.de

Evidence rating
Possibly beneficial
Studies overview

The programme has been evaluated in one randomised controlled trial in Germany, with children aged 12-15 years. There was a statistically significant effect favouring the intervention on alcohol-related knowledge at post-test and one-year follow-up, and self-reported life-time binge drinking at follow-up (but not at post-test). There was no effect on self-reported alcohol-related intentions, past-month alcohol use, life-time alcohol use or drunkenness at post-test or follow-up. The intervention condition had significantly more favourable attitudes towards alcohol consumption at post-test than the control condition, although this difference was not statistically significant at the follow-up (one year after pre-test).

References of studies

*Morgenstern, M., Wiborg, G., Isensee, B. and Hanewinkel, R. (2009), ‘School‐based alcohol education: results of a cluster‐randomized controlled trial’, Addiction 104, pp. 402-412.

Countries where evaluated
Germany
Protective factor(s) addressed
No defined protective factors
Risk factor(s) addressed
Family: parental attitudes favourable to alcohol/drug use
Individual and peers: peers alcohol/drug use
Outcomes targeted
Alcohol use
Use of illicit drugs
Description of programme

Aktion Glasklar is a school-based programme delivered to secondary school students with the aim of preventing them from consuming alcohol. After attending a three-hour workshop on the intervention, teachers deliver four units to students in classes over a three-month period, as well as circulating educational brochures about alcohol to both parents and students. The students’ booklet contains information about key issues (e.g. alcohol and the developing brain); the intention is that students will gain knowledge about alcohol and the consequences of alcohol use.

The booklet for parents provides general information about alcohol and gives behavioural advice for age-appropriate interactions with their offspring. The four class units delivered by teachers follow a standard curriculum, each one being underpinned by a specific theme with main objectives and a list of materials. The four units aim to educate students about alcohol use and cover the topics of what is actually permitted, advertising, temptation and when drinking alcohol may be OK.

Last updated : 09.01.2024
Country of origin
USA
Last reviewed:
Age group
0-5 years
Target group
0-2 years
Programme setting(s)
Family
Level(s) of intervention
Targeted intervention

Nurse-Family Partnership begins during pregnancy, as early as is possible, and continues until the child’s second birthday. Nurses work with low-income pregnant mothers bearing their first child to improve the outcomes of pregnancy, infant health and development, and the mother’s own personal life-course development through instruction and observation during home visits. These visits generally occur every other week and last 60-90 minutes.


A Dutch study adapted the programme for Dutch women and their healthcare system by placing more emphasis on home delivery, instructing women to stop smoking during pregnancy and offering more information about the advantages of breastfeeding.

Keywords
No data
Links to this programme in other registries
USA - Blueprints Programs
Germany - Grüne Liste Prävention
UK - Early Intervention Foundation Guidebook
Contact details

Professor David Olds, PhD
University of Colorado Health Sciences Centre
Prevention Research Centre for Family and Child Health
1825 Marion St, Denver 80220
United States of America
Email: olds.david[a]tchden.org
Website: www.nursefamilypartnership.org/

Evidence rating
Possibly beneficial
Studies overview

The programme has been evaluated in three randomised controlled trials (RCTs) in Europe: in Germany with financially or socially disadvantaged first-time mothers; in England with nulliparous women aged 19 years or younger; and in the Netherlands with nulliparous women aged 25 years or younger with a low level of education.

The German study found no impact on birth outcomes – weight, height or head circumference – and no effect on children’s fine and gross motor abilities or language at any time-point. However, there was a statistically significant effect favouring the intervention on infants’ cognitive abilities at 12 months (but not at six or 24 months) and on mothers reading or telling stories at 24 months (but not at 6 or 12 months). An analysis of a subgroup – participants who had taken part in the first three assessments (end of pregnancy, six months and 12 months) by the end of 2008 found no statistically significant difference between intervention and control conditions in mothers’ smoking habits.

The English study found no effects on any of four birth outcomes, smoking outcomes for mothers (proportion of mothers who smoked and number of cigarettes smoked per day at late pregnancy) or the majority of secondary outcomes. There were small positive impacts on the following secondary outcomes: intention-to-breastfeed; maternal-reported child cognitive development (at 24 months only); language development using a modified maternal-reported assessment (at 12 and 18 months) and a standardised assessment (at 24 months); levels of social support; partner-relationship quality; and general self-efficacy.

In the Dutch study, there were statistically significant effects favouring the intervention on smoking: fewer women in the intervention condition smoked during and after the birth, and they smoked fewer cigarettes per day after the birth and fewer cigarettes in the presence of the baby. There was also a statistically significant positive impact on domestic violence (two of 10 measures of victimisation, and one of 10 measures of perpetration) and breastfeeding at six months. There were no effects on pregnancy outcomes, such as birthweight, weeks of gestation, low birthweight, prematurity and the baby being small for their gestational age. Two other statistically significant effects favouring the intervention condition were child protection reports at 36 months and the prevalence of children with internalising (but not externalising) behaviour at 24 months.

The programme has been rated as Model by Blueprints for Healthy Youth Development based on a review of studies conducted world-wide.

References of studies

Eckenrode, J., Campa, M., Luckey, D. W., Henderson, C. R., Cole, R., Kitzman, H., Anson, E., et al. (2010), ‘Long-term effects of prenatal and infancy nurse home visitation on the life course of youths: 19-year follow-up of a randomized trial’, Archives of Pediatrics and Adolescent Medicine 164, pp. 9-15.


*Jungmann, T., Ziert, Y., Kurtz, V. and Brand, T. (2009), ‘Preventing adverse developmental outcomes and early onset conduct problems through prenatal and infancy home visitation: the German pilot project “Pro Kind”’, European Journal of Developmental Science 3, pp. 292-298.

Kitzman, H, Olds, D. L., Henderson, C. R., Hanks, C., Cole, R. Tatelbaum, R., McConnochie, K. M., et al. (1997), ‘Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing’, Journal of the American Medical Association 278, pp. 644-652.

Kitzman, H., Olds, D. L., Henderson, C. R., Jr., Hanks, C., Cole, R., Tatelbaum, R., McConnochie, K. et al. (1997), ‘Randomized trial of prenatal and infancy home visitation by nurses on the outcomes of pregnancy, dysfunctional caregiving, childhood injuries, and repeated childbearing among low-income women with no previous live births’, The Journal of the American Medical Association (under review).


Kitzman, H., Olds, D. L., Cole, R. E. Hanks, C. A., et al. (2010), ‘Enduring effects of prenatal and infancy home visiting by nurses on children: follow-up of a randomized trial among children at age 12 years’, Archives of Pediatrics and Adolescent Medicine 164, pp. 412-418.


*Mejdoubi, J., van den Heijkant, S. C. C. M., van Leerdam, F. K. M., Heymans, M. W., Hirasing, R. A. and Crijnen, A. A. M. (2013), ‘Effect of nurse home visits vs. usual care on reducing intimate partner violence in young high-risk pregnant women: a randomized controlled trial’, PLOS One, DOI: 10.1371/journal.pone.007818.

*Mejdoubi, J., van den Heijkant, S. C. C. M., van Leerdam, F. K. M., Crone, M, Crijnen, A. and HiraSing, R. A. (2014), ‘Effects of nurse home visitation on cigarette smoking, pregnancy outcomes and breastfeeding: a randomized controlled trial’, Midwifery 30, pp. 688-695.

*Mejdoubi, J., van den Heijkant, S. C., van Leerdam, F. J., Heymans, M. W., Crijnen, A. and Hirasing, R. A. (2015), ‘The effect of VoorZorg, the Dutch Nurse-Family Partnership, on child maltreatment and development: a randomized controlled trial’, PLOS One 10.

Olds, D. L., Henderson, C. R., Chamberlin, R. and Tatelbaum, R. (1986), ‘Preventing child abuse and neglect: a randomized trial of nurse home visitation’, Pediatrics 78, pp. 65-78.

Olds, D. L., Henderson, C. R., Tatelbaum, R. and Chamberlin, R. (1986), ‘Improving the delivery of prenatal care and outcomes of pregnancy: a randomized trial of nurse home visitation’, Pediatrics 77, pp. 16-28.


Olds, D. L., Henderson, C. R. and Kitzman, H. (1994), ‘Does prenatal and infancy nurse home visitation have enduring effects on qualities of parental caregiving and child health at 25 to 50 months?’, Pediatrics 93, pp. 89-98.


Olds, D. L., Eckenrode, J., Henderson, C. R., Kitzman, H., Powers, J., Cole, R. Sidora, K., et al. (1997), ‘Long-term effects of home visitation on maternal life course and child abuse and neglect: 15-year follow-up of a randomized trial’, Journal of the American Medical Association 278, pp. 637-643.


Olds, D. L., Henderson, C. R., Cole, R., Eckenrode, J., Kitzman, H., Luckey, D., Pettitt, L., et al. (1998), ‘Long-term effects of Nurse Home Visitation on children’s criminal and antisocial behavior: 15-year follow-up of a randomized controlled trial’, Journal of the American Medical Association 280, pp. 1238-1244.


Olds, D. L., Robinson, J., O’Brien, R., Luckey, D. W., Pettitt, L. M., Henderson, C. R., Ng, R. K., et al. (2002), ‘Home visiting by paraprofessionals and by nurses: a randomized, controlled trial’, Pediatrics 110, pp. 486–496.


Olds, D. L., Kitzman, H., Cole, R., Robinson, J., Sidora, K., Luckey, D. W., Henderson, Jr., C. R., et al. (2004), ‘Effects of nurse home visiting on maternal life course and child development: age 6 follow-up results of a randomized trial’, Pediatrics 114, pp. 1550-1559.

Olds, D. L., Robinson, J., Pettitt, L., Luckey, D. W., Holmberg, J., Ng, R. K., Isacks, K., et al. (2004), ‘Effects of home visits by paraprofessionals and by nurses: age 4 follow-up results of a randomized trial’, Pediatrics 114, pp. 1560-1568.

Olds, D. L., Kitzman, H., Hanks, C., Cole, R., Anson, E., Sidora-Arcoleo, K., Luckey, D. W., et al. (2007), ‘Effects of Nurse Home Visiting on maternal and child functioning: age 9 follow-up of a randomized trial’, Pediatrics 120, pp. 832-845.


Olds, D. L., Kitzman, H., Cole, R., Hanks, C., Arcoleo, K., Anson, E., Luckey, D., et al. (2010), ‘Enduring effects of prenatal and infancy home visiting by nurses on maternal life course and government spending: follow-up of a randomized trial among children at age 12 years’, Archives of Pediatrics and Adolescent Medicine 164, pp. 419-424.


Olds, D. L., Kitzman, H., Knudtson, M. D. and Anson, E. (2014), ‘Effect of home visiting by nurses on maternal and child mortality: results of a 2-decade follow-up of a randomized clinical trial’, JAMA 472, E1-7 (published online 7 July 2014).

*Robling, M., Bekkers, M. J., Bell, K., Butler, C. C., Cannings-John, R., Channon, S., ... and Torgerson, D. (2015), ‘Effectiveness of a nurse-led intensive home-visitation programme for first-time teenage mothers (Building Blocks): a pragmatic randomised controlled trial’, The Lancet 387, pp. 146-155.

*Sandner, M. (2013), ‘Effects of early childhood intervention on child development and early skill formation: evidence from a randomized controlled trail (No. 518)’, Discussion Paper, Wirtschaftswissenschaftliche Fakultät, Leibniz Universität Hannover.

*Sierau, S., Dähne, V., Brand, T., Kurtz, V., von Klitzing, K. and Jungmann, T. (2015), ‘Effects of home visitation on maternal competencies, family environment, and child development: a randomized controlled trial’, Prevention Science 17, pp. 40-51.

Countries where evaluated
Germany
Netherlands
United Kingdom
Protective factor(s) addressed
Family: attachment to and support from parents
Family: attachment to and support from romantic partner
Family: opportunities/rewards for prosocial involvement with parents
Family: parent social support
Risk factor(s) addressed
Family: aggressive or violent parenting
Family: family conflict
Family: Family history or involvement with substance abuse/problem behaviour
Family: family management problems
Family: family/individual poverty
Family: mother substance use during pregnancy
Family: neglectful parenting
Family: parental attitudes favourable to alcohol/drug use
Family: parental attitudes favourable to anti-social behaviour
Family: parental depression or mental health difficulties
Family: unintended child birth (parent)
Individual and peers: anti-social behaviour
Individual and peers: early initiation of drug/alcohol use
Outcomes targeted
Academic performance
Other educational outcomes
Talking and reading
Depression or anxiety
Emotion regulation, coping, resilience
Other mental health outcomes
Chronic health problems
Other health outcomes
Relations with parents
Alcohol use
Use of illicit drugs
Smoking (tobacco)
Crime
Other behaviour outcomes
Risky sex, STIs, teen pregnancy
Description of programme

Nurse-Family Partnership sends nurses to the homes of pregnant women who are predisposed to infant health and developmental problems (i.e. at risk of pre-term delivery and low-birth-weight children). The goal is to improve parent and child outcomes. Treatment begins during pregnancy, with 60- to 90-minute visits about once every other week, and continues to 24 months post-partum. Programme content covered in the home visits includes (i) parent education about influences on fetal and infant development; (ii) the involvement of family members and friends in the pregnancy, birth and early care of the child, and support for the mother; and (iii) linking family members with other formal health and social services.


Specific objectives include improving women’s diets; helping women monitor their weight gain and eliminate the use of cigarettes, alcohol and drugs; teaching parents to identify the signs of complications in pregnancy; encouraging regular rest, appropriate exercise and good personal hygiene related to obstetrical health; and preparing parents for labour, delivery and early care of the newborn.


In addition to working with mothers directly, nurses promote the goals of the programme by engaging other family members and close friends in the programme and by helping families to use other formal health and social services.


A Dutch study (Mejdoubi et al., 2013) adapted the programme for Dutch women and their healthcare system. The most important adaptations included placing more emphasis on home delivery, instructing women to stop smoking during pregnancy and offering more information about the advantages of breastfeeding.

Last updated : 29.11.2024
Country of origin
Italy
Last reviewed:
Age group
11-14 years
Target group
Children aged 12-14 years
Programme setting(s)
School
Level(s) of intervention
Universal prevention

Unplugged is a school-based programme that incorporates components focusing on critical thinking, decision making, problem solving, creative thinking, effective communication, interpersonal relationship skills, self-awareness, empathy, coping with emotions and stress, normative beliefs, and knowledge about the harmful health effects of drugs. The curriculum consists of 12 one-hour units taught once a week by class teachers who have previously attended a 2.5-day training course.

Keywords
No data
Links to this programme in other registries
Germany - Green List Prevention
UK - CAYT - mentor-adepis
Poland - Programy rekomendowane
Contact details

Professor Federica Vigna-Taglianti, PhD
University of Torino
Regione Gonzole, 10 - 10043 Orbassano (TO),
Italy
Email: federica.vignataglianti[a]unito.it

Johan Jongbloet
HOGENT university of applied sciences and arts
Valentin Vaerwyckweg 1, 9000 Gent,
Belgium
Email: Johan.jongbloet[a]hogent.be

Professor Fabrizio Faggiano, PhD
Avogadro University
Via Solaroli 1
Novara, Italy
Email: fabrizio.faggiano[a]uniupo.it

Show link
0
Evidence rating
Beneficial
Studies overview

The programme has been evaluated in a cluster randomised controlled trial (RCT) involving children aged 12-14 years in several European countries: Austria, Belgium, Germany, Greece, Italy, Spain and Sweden (Caria et al., 2010; Faggiano et al., 2007, 2008, 2010; Giannotta et al., 2014; Vigna-Taglianti et al., 2009, 2014). There were also two cluster RCTs in the Czech Republic (Miovsky et al., 2012; Jandáč et al., 2021) involving children with a mean age of respectively 11.8 years and 15 years.

For the cross-country study at post-test, exposure to Unplugged was associated with a statistically significant lower prevalence of self-reported daily use of cigarettes, episodes of drunkenness and cannabis use in the past 30 days in the intervention condition compared with the control condition. Young people receiving the programme were less likely than those in the control condition to move from non-smoking or sporadic smoking to daily smoking. Similar patterns emerged in the use of other substances. An analysis by gender found that delayed progression and enhanced regression were higher in the intervention condition among boys, whereas no, minimal or reverse differences were observed among girls.

At 18-month follow-up (Faggiano et al., 2010; Vigna-Taglianti et al., 2014), the use of tobacco and frequency of drunkenness was lower among students in the intervention condition compared to those in the control condition. Students in the intervention condition showed higher tendencies to remain non-users of tobacco or to regress from occasional to no use. The number of students reporting no drunkenness in the past 30 days was higher among students in the intervention condition compared to those in the control condition. Intervention condition participants also reported fewer alcohol-related behaviour problems compared to controls. Further, participants who reported not drinking at baseline were more likely to retain this status at follow-up after participating in the intervention, and those who reported drinking only occasionally at baseline showed a slower progression towards frequent drinking by follow-up if they participated in the intervention. When considering cannabis use, the proportion of persistent non-users was higher among the intervention condition than the control condition. All of these differences were statistically significant.

The first Czech study (Miovsky et al., 2012) found a statistically significant effect favouring the intervention, with intervention participants less likely than those in the control condition to have smoked cigarettes in the last 30 days at 3-, 15- and 24-months post-intervention. At the other two time periods (1 and 12 months), differences between conditions in 30-day cigarette use were not statistically significant. There were no statistically significant differences between intervention and control conditions on lifetime cigarette prevalence rates.


The second Czech study (Jandáč et al., 2021) consisted of 70 schools randomly selected with stratification according to their affiliation with a region and size, assigned to one of three groups (the control group, the intervention group 1 and the intervention group 2 exposed to the Unplugged intervention and n-Prevention. The n-Prevention programme is a follow-up (12 months) programme and consists of four lessons providing a general background addressing social norms, social beliefs, refusal skills and gender-specific differences, neurological aspects and the effects of substance use.  Children from families where the mother reported using alcohol weekly or less frequently, however, reported a decrease in drunkenness in the last 30 days compared to the control group. However, the study found no statistically measurable effect on drinking among children who came from families where the mother uses alcohol more than weekly.  These results were observed at a 24-month follow-up, which implies that the Unplugged programme may not be sufficient for high-risk children. Moreover, it is unclear how randomisation took place, and what the drop-out rate and baseline equivalence was. Additionally, in this study, a universal programme was used as a targeted intervention.

Lecrique et al. (2019) conducted an RCT in France to assess the effectiveness of the intervention on drug use among adolescents. Measures were taken at baseline and 6 and 8 months follow-up. The results showed that at the 8-month follow-up, the probability of consumption of cigarettes (OR=0.36; p<0.01), being drunk (OR=0.23, p<0.01) or using cannabis (OR=0.31, p<0.05) in the last 30 days was higher in the control group compared to the intervention group. In the intervention group, there was an improvement in other outcomes including psychosocial skills, reduced peer perception of substances and increased knowledge of the effects of substances. However, the study is a non-peer-reviewed report, it is not clear how randomisation was carried out, and there is no information on the level of attrition.

The RCTs conducted in Slovakia (Orosová et al., 2020; Abrinkova et al., 2021; Curova et al., 2021; Orosova et al., 2022) were not included in the assessment as the quality of the randomisation was low. The outcome measurement took place shortly after implementation in a quite young target group (11).

References of studies

Studies Included in the Assessment: 

Caria, M. P., Faggiano, F., Bellocco, R., & Galanti, M. R., & EU-Dap Study Group. (2010). Effects of a school-based prevention programme on European adolescents’ patterns of alcohol use. Journal of Adolescent Health, 48(2), 182-188

Faggiano, F., Richardson, C., Bohrn, K., & Galanti, M. R. (2007). A cluster randomized controlled trial of school-based prevention of tobacco, alcohol and drug use: The EU-Dap design and study population. Preventive Medicine, 44(2), 170-173.

Faggiano, F., Galanti, M. R., Bohrn, K., Burkhart, G., Vigna-Taglianti, F., Cuomo, L., Fabiani, L., & EU-Dap Study Group. (2008). The effectiveness of a school-based substance abuse prevention programme: EU-Dap cluster randomized controlled trial. Preventive Medicine, 47(5-6), 537-543.

Faggiano, F., Vigna-Taglianti, F., Burkhart, G., Bohrn, K., Cuomo, L., Gregori, D., Panella, M., & EU-Dap Study Group. (2010). The effectiveness of a school-based substance abuse prevention programme: 18-month follow-up of the EU-Dap cluster randomized controlled trial. Drug and Alcohol Dependence, 108(1-2), 56-64.

Giannotta, F., Vigna-Taglianti, F., Galanti, M. R., Scatigna, M., & Faggiano, F. (2014). Short-term mediating factors of a school-based intervention to prevent youth substance use in Europe. Journal of Adolescent Health, 54(5), 565-573.

Lecrique JM. Évaluation d’Unplugged dans le Loiret, programme de prévention de l’usage de substances psychoactives au collège.Saint‑Maurice : Santé publique France; mai 2019. 2 p.Rapport complet disponible à partir de l’URL: http://www.santepubliquefrance.fr/

Miovsky, M., Novak, P., Stastina, L., Gabrhelik, R., Jurystova, L., & Vopravil, J. (2012). The effect of the school-based Unplugged preventive intervention on tobacco use in the Czech Republic. Adicciones, 24(3), 211-218.

Vigna-Taglianti, F., Vadrucci, S., Faggiano, F., Burkhart, G., Siliquini, R., & Galanti, M. R. (2009). Is universal prevention against youths’ substance misuse really universal? Gender-specific effects in the EU-Dap school-based prevention trial. Journal of Epidemiology and Community Health, 63(9), 722-728. 
 
Vigna-Taglianti, F. D., Galanti, M. R., Burkhart, G., Caria, M. P., Vadrucci, S., & Faggiano, F. (2014). “Unplugged,” a European school-based programme for substance use prevention among adolescents: Overview of results from the EU-Dap trial. New Directions for Youth Development, 2014(141), 67-82.

Studies not Included in the Assessment: 

Abrinkova, L., Orosová, O., De Jesus, S. N., Gajdošová, B., & Bacikova-Sleskova, M. (2021). Resilience Factors, the School-Based Universal Prevention Program “Unplugged” and Healthy Behavior among Early Adolescents. European Journal of Mental Health, 16(2), 55–75. https://doi.org/10.5708/ejmh.16.2021.2.3

Čurová, V., Orosová, O., Abrinková, L., & Štefaňáková, M. (2021). The Effectiveness of Drug Use Prevention Programs on Substance Use among Slovak Schoolchildren. In Psychology Developments and Applications VII. https://doi.org/10.36315/2021padvii12

Orosová, O., Gajdošová, B., Bacíková-Šléšková, M., Benka, J., & Bavol’ár, J. (2020). Alcohol Consumption among Slovak Schoolchildren: Evaluation of the Effectiveness of the Unplugged Programme. Adiktologie, 20, 89-96

Orosová, O., Gajdošová, B., & Benka, J. (2022). Serial Mediation Models Testing the Effect of a School-Based Prevention Program on Smoking and Alcohol Consumption.  https://doi.org/10.36315/2022padviii15
 

Countries where evaluated
Austria
Belgium
Czechia
Germany
Italy
Spain
Sweden
France
Protective factor(s) addressed
Individual and peers: Problem solving skills
Individual and peers: skills for social interaction
Risk factor(s) addressed
No defined risk factors
Outcomes targeted
Alcohol use
Use of illicit drugs
Smoking (tobacco)
Description of programme

Unplugged is a school-based programme that incorporates components focusing on critical thinking, decision-making, problem-solving, creative thinking, effective communication, interpersonal relationship skills, self-awareness, empathy, coping with emotions and stress, normative beliefs, and knowledge about the harmful health effects of drugs. Unplugged particularly emphasised correcting pupils' beliefs about the pervasiveness of substance use ('normative beliefs') by contrasting these with data from surveys of pupils of the same age which typically reveal that average use levels are lower. 

The curriculum consists of 12 one-hour units taught once a week by class teachers who have previously attended a 2.5-day training course in the lessons and materials, and in how to teach them using methods which encourage interaction between pupils and between pupils and teachers, such as role-play and giving and receiving feedback in small groups. Based on teacher feedback and barriers identified during the first implementations of Unplugged, the revised programme's lessons are: 1. Opening Unplugged, 2. To be or not to be in a group, 3. Choices – Alcohol, Risk and Protection, 4. Your beliefs, norms and information – do they reflect reality? 5. Smoking the cigarette drug – Inform yourself, 6. Express yourself, 7. Get up, stand up, 8. Party Tiger, 9. Drugs - Get informed, 10. Coping competences, 11. Problem solving and decision making, 12. Goal-setting.

Materials can be accessed for free here.

This basic curriculum is ideally supplemented either by meetings led by pupils selected by their classmates, or by workshops for the pupils' parents. While in the implementations for the first trial, the curriculum was moderately well implemented, peer-led activities were rarely conducted, few parents attended the workshops, and an important element – role-play – was generally omitted by teachers.

Implementation Experiences
Feedback date
Contact details

Maria Kyriadikou
mkyriakidou[a]pyxida.org.gr

Main obstacles

With respect to individual professionals

Unplugged is implemented by teachers after training; however, teachers are often unfamiliar with group work and interactive learning methods and may lack the motivation to consistently apply these methods in the classroom.

With respect to social context

Schools often do not provide the necessary time and space to implement prevention programmes like Unplugged. Since it is not part of the school curriculum, its implementation largely depends on teachers' willingness.

With respect to organisational and economic context

Prevention programmes should be officially a part of the school curriculum in order for them to be sustainable.

How they overcame the obstacles

With respect to individual professionals

By offering training that emphasizes interactive methods, allowing teachers to directly experience the benefits, and providing ongoing support as they implement the programme in their classrooms.

With respect to social context

By trying to motivate teachers and school directors in order to allow the programme to be implemented in their school.

With respect to organisational and economic context

By providing the necessary material to teachers and by offering the training for free.

Lessons learnt

With respect to individual professionals

Prevention programmes must consider that teachers typically use conservative teaching methods and adapt the curriculum accordingly by offering alternatives to interactive methods.
Or that prevention programmes should be delivered by professionals who are familiar with group work and interactive methods.

With respect to social context

Prevention programmes should be officially a part of the school curriculum in order for them to be sustainable.

With respect organisational and context

Prevention programmes should be embedded in the organisational context of schools in order for them to have the necessary resources.

Strengths

Attractiveness of the material, effectiveness of the prevention programmes, enthusiastic trainers and teachers.

Weaknesses

Lack of contextual framework for school implementation, limited dissemination, and training materials should be updated with current information on drug abuse.

Opportunities

Prevention of drug abuse among teenagers, professional and personal development of teachers.

Threats

No maintenance of the implementation.

Recommendations

With respect to individual professionals

Put more effort into recruiting and training.

With respect to social context

Assure alliances.

With respect to organisational and economic context

Secure resources.

Number of implementations
1
Country
Greece
Feedback date
Contact details

Juan Carlos Melero
jcmelero[a]edex.es

Main obstacles

With respect to individual professionals

Limited training for secondary school teachers in programme-relevant content, group dynamics, and psychosocial skills.

With respect to social context

1. The diversity of preventive programmes in Spain at present (more than 100 according to the reports of the National Plan on Drugs).
2. A certain lack of motivation on the part of the teaching staff.
3. Difficulty participating in training sessions over several hours.

With respect to organisational and economic context

Due to the ongoing effects of the economic crisis in Spain, securing adequate funding for programmes like Unplugged is challenging.

How they overcame the obstacles

With respect to individual professionals

Providing highly practical training sessions where teachers experience Unplugged’s proposed dynamics. A team of professionals from various Spanish regions meets annually to reflect on and improve the ongoing training process.

With respect to social context

1. Highlighting the available scientific evidence, although it has not been a motivating criterion either.
2. Implementing mechanisms for monitoring presence and online that facilitate the solution of doubts to teachers.
3. Dynamising formative processes of variable duration (between 3 and 10 hours) and looking for dynamics of online training.

With respect to organisational and economic context

Trying to find funding from private companies and, above all, seeking co-financing from the administrations in whose territories the programme is developed.

Lessons learnt

With respect to individual professionals

It may be convenient to devise online training proposals that seek the maximum interaction that enables face-to-face training. We are launching tools of this type in our Ibero-American School of Life Skills: http://escuela.habilidadesparalavida.net/

With respect to social context

Flexibility in programme implementation is essential. Although it is ideal to follow the evaluated technical model strictly, balancing technical rigor with the schools’ capacity for long-term programme adoption is necessary, especially in the context of low societal concern around drugs today.

With respect to organisational and economic context

Although it does not seem easy to achieve, it would be advisable to look for ways in which the educational centres themselves could contribute to the financing of the project activities: training, materials, etc., even if it was a symbolic percentage.

Strengths

Scientific evidence, European value, socio-emotional skills.

Weaknesses

Duration, training, competition with other programmes.

Opportunities

Evidence, recognition by public institutions.

Threats

Sustainability in times of crisis.

Recommendations

With respect to individual professionals

Focus teacher training on developing socio-emotional skills applicable to related topics, such as sex education.

With respect to social context

Explore formative formats that facilitate the participation of teachers, seeking balance and respect for the diversity of existing motivations.

With respect to organisational and economic context

Look for ways of co-financing that contribute to making the programme sustainable without great expense to anyone.

Number of implementations
1
Country
Spain
Feedback date
Contact details

Maria Rosaria Galanti
rosaria.galanti[a]ki.se
 

Main obstacles

With respect to individual professionals

The programme was time consuming and required more school-time than expected.

With respect to social context

None that I am aware of.

With respect to organisational and economic context

Schools in Sweden are autonomous organisations with considerable variation in programmes and pedagogy, which must be considered for successful programme implementation.

How they overcame the obstacles

With respect to individual professionals

During the experimental phase, teachers received support through reinforcement measures and a help desk. However, there was no formal dissemination phase in Sweden.

With respect to organisational and economic context

In the experimental phase, site visits were very helpful in order to "adjust" the programme to organisational constraints.

Lessons learnt

With respect to individual professionals

Demanding programmes such as Unplugged, if adopted at all, have a high potential for unsurveilled modifications/adaptations that, with time, make the programme quite different from that originally developed.
In addition, the lack of specific contextual effects undermines the programme's diffusion.

With respect to organisational and economic context

A structured and manualised programme is more difficult to implement in highly variable organisational settings than an unstructured programme.

Strengths

The scientific environment in which the programme was developed and evaluated, as well as the initial interest shown by recipients.

Weaknesses

The lack of flexibility of the programme to highly variable organisations.

Opportunities

To learn in the school environment.

Threats

The lack of convincing results on many outcomes; the lack of resources for active diffusion and support to the recipients (schools).

Recommendations

With respect to individual professionals

Care about motivation and preparedness to adopt evidence-based demanding programmes.

With respect to social context

Is the goal of the programme shared by political/professional stakeholders? Is it a priority?

With respect to organisational and economic context

Obtain central approval from school authorities whenever possible.

Number of implementations
1
Country
Sweden
Feedback date
Contact details

Martina Feric
martina.feric[a]erf.hr
 

Main obstacles

With respect to individual professionals

Professionals in the schools (social pedagogues) were highly motivated for programme implementation. There was less motivation from the teachers (seeing their involvement in programme as extra (and not paid) job).

With respect to social context

Parent participation was relatively low.

With respect to organisational and economic context

There was the problem to find one school hour extra in school day for programme implementation. Also, in original programme, there are too many activities planned for one lesson (time frame of one lesson in Croatia is 45 minutes) and it wasn't possible to do all activities in 45 minutes. The same problem applied to the parent arm.

How they overcame the obstacles

With respect to individual professionals

Trainers, supervisors, and social pedagogues made special efforts to enhance teacher motivation. This included making training sessions as interactive and enjoyable as possible, addressing teachers’ anticipated concerns, and maintaining flexibility (while preserving programme fidelity) during delivery. Social pedagogues were also present in the classroom for some lessons if teachers found certain lessons challenging.

With respect to social context

Efforts were made to encourage parent participation through various methods, including sharing information at parent meetings, sending personal letters, and displaying posters at schools.

With respect to organisational and economic context

Most of the school used “class hour” to do the Unplugged.
We worked with the teachers and social pedagogues on shortening activities and, at the same time, keeping the integrity of the programme (e.g. changing the introduction game; in some cases quiz was taken in the class and not in the small groups; discussion instead of role-playing with parents).

Lessons learnt

With respect to individual professionals

Time and effort must be invested to “prepare” schools for implementation. This includes presenting the programme to all school staff and clearly communicating organisational needs for implementation. The role of the school principal is crucial, as real support is needed for effective implementation—not just verbal encouragement.

With respect to social context

There is a need for a pilot programme in order to adapt a programme originating elsewhere to this social/cultural context.

With respect to organisational and economic context

The input of participants from programme pilot phase was valuable and had important role in planning organisational aspects of implementation.

Strengths
  1. The advantage of implementing a programme that originated elsewhere is implementing the effective prevention programme with all technical support (training of the people in charge, training of teachers, handbooks, workbooks, protocol for process evaluation etc.). In Croatia there is a lack of model programmes.
  2. The professionals in the schools (social pedagogues) have competencies to deliver the programme and support the teachers in delivery.
Weaknesses

Problem of finding the “space” to deliver a programme in a school day.

Opportunities
  1. Successful implementation of an effective programme from elsewhere with high fidelity is feasible.
  2. Successful implementation of an effective programme can enhance use of quality standards in school-based prevention on national level.  
Threats

The acceptance of tobacco and alcohol use is still high in Croatia and there is a high tolerance towards alcohol use by adults (parents don’t see alcohol and tobacco use as “a big problem”; more like “part of growing up”).

Recommendations

With respect to individual professionals

It is important to assure quality training for programme providers (small groups to ensure maximum interactivity and sharing). If it is possible, supervision should be provided.

With respect to social context

There is a need to invest in preparing schools for programme implementation in the sense of sensitisation and motivation. Having motivated teachers and school counsellors in order to ensure programme fidelity is crucial. Also, it is important to have motivated and supportive school management.

With respect to organisational and economic context

Programme pilot implementation can help to adapt programme delivery to given context and, at the same time, to keep fidelity to the programme.

Note from the authors

Imam stav - Unplugged

Number of implementations
1
Country
Croatia
Feedback date
Main obstacles

With respect to individual professionals

Trained school-based prevention specialists manage the intervention effectively. However, there is limited information on how class teachers are implementing the intervention.

With respect to social context

The intervention is getting old and outdated.

With respect to organisational and economic context

Length of the intervention; 12 lessons to be implemented in one academic school year in all classes in 6th grade (e.g., if one school has 3 classes in a grade this leaves us with 36 lessons to be implemented by how many teachers?)
Cost related to coloured workbook that every child should have.
For some (definitely not for all) costs of + time devoted to the training.

How they overcame the obstacles

With respect to individual professionals

A 2-day training was provided for Unplugged implementation.

With respect to social context

We tried to develop and implement other interventions.

With respect to organisational and economic context

Motivating the implementers.
Implementers were motivated and informed about the importance of maintaining fidelity, with only minor content and delivery modifications permitted.

Lessons learnt

With respect to individual professionals

Emphasize training, clear explanation, motivation, and education.

With respect to social context

Interventions must be multicomponent, addressing more types of risk behaviours, involving more target groups, systematic.
Collaboration with intervention deliverers is essential.

With respect to organisational and economic context

Reducing the number of lessons and replacing coloured workbooks with black-and-white worksheets may improve feasibility.

Strengths

Used and evaluated in Europe widely, High level promotion.

Weaknesses

No successor at hand.

Opportunities

Important lessons learnt from research outcomes.

Threats

Intervention is getting old, Low control of all aspects of fidelity.

Recommendations

With respect to individual professionals

Needs to be revised/updated prior to implementation.

With respect to social context

Needs to be revised/updated prior to implementation.

With respect to organisational and economic context

Needs to be revised/updated prior to implementation.

Number of implementations
1
Country
Czechia
Feedback date
Contact details

Sanela Talić
sanela[a]institut-utrip.si

 

Main obstacles

With respect to individual professionals

  1. If the teachers voluntarily participated in the training and implementation, the results and their commitment were on a high level.
  2. Another problem was with inclusion of the Unplugged lessons in regular curriculum. Some teachers were claiming that they don't have available lessons for Unplugged although they have flexible curriculum (which means they have many possibilites to incorporate Unplugged lessons in usual lessons). They are afraid to be autonomous so they follow their handbooks because they feel safer that way and don't want to interrupt their routine - there is no cross-curricular integration. Because of the extent of some lessons, those couldn't be implemented in one school hour (45 minutes).
  3. They also think that drug prevention is mostly providing information on drugs and as they don't have knowledge they are not competent to do preventive work.
  4. There are some cases where teachers want to use Unplugged lessons within school camps and do all lessons in a few consecutive days. That approach strongly deviates from the original plan and we don’t recommend it (this is no longer “Unplugged”) – but we don’t have control over it.

With respect to social context

  1. Opinion of some teachers was that prevention should start in early school years (even before) and that parents should be more cooperative. According to their experiences children do not have basic set of manners and values (when they enter the school). Pupils bring family problems to school and all attention is given to solving those problems. It means there is less time for education and learning or strengthening different life skills. They don't feel competent for problem solving, building authority, productive teaching etc.
  2. Low participation of parents.
  3. Prevention in general is not considered as something we do “before problems occur” and often it is connected with substance use. There is no overview over who does the prevention in schools, how it is done, the only thing that matters is that “prevention activities” in a year plan are ticked.
  4. It is very hard to find motivated teachers who are willing to do additional “prevention work”. Schools are not obliged to do “prevention”; at least, the Ministry of Education doesn’t have any expectations, rules and standards regarding prevention work in schools.
  5. In our opinion, wider implementation of quality standards (and the programme) is also hampered by incorrect relations between Ministry of Health and Ministry of Education (prevention programmes are financed by Ministry of Health without agreement or cooperation with Ministry of Education).
How they overcame the obstacles

With respect to individual professionals

Teachers felt more confident knowing that I'm a teacher by profession and that am aware of situation mentioned above. As I am a teacher and know that there are a lot of possibilities to incorporate other content (like Unplugged), I helped them to make a plan, share ideas and experiences from other schools. After the training they realised that drug prevention is not just talking and giving information about drugs. As most of the teachers usually like to follow the instructions, the workbook with detailed instructions for every lesson helped them to feel more confident.

We decided that all training activities will be led by a teacher who has been implementing Unplugged since the very beginning. So, there is an impression that the programme is used in practice, that it can be implemented and new teachers get much practical advice and recommendations from a person who has implemented it over many years.

With respect to social context

Through all these years we have been promoting prevention science and its principles, we have been organising “Slovenian Prevention Days” and training for Unplugged. Beside “Unplugged training” we also offer some basic information on what, how and why some approaches work/don’t work/have iatrogenic effects.

This year we finally got in contact with stakeholders from the Ministry of Education and started to think how to ensure enough school hours for prevention programmes only. The main idea is to ensure at least one whole hour a week (for every single class) – from the beginning till they finish the school.

Regarding low participation of parents - Parents do not want to immediately expose themselves and participate in activities that are provided by original workshops. There is not enough time to create safe environment where parents would cooperate without any reservations. That is why we decided to implement school based prevention programme EFFEKT for parents and to take advantage of parents’ meetings for its implementation. The rate of parents who are taking part in it is around 85%. We are still in the pilot phase of it. And in the future we plan to do research on effectiveness of each individual programme and a combination of both.

Lessons learnt

With respect to individual professionals

Every year (with lot of advocacy and promotion of the programme) we manage to find at least one/two teachers from each interested school who are willing to implement Unplugged and all of them are very motivated after the training. Each year we organise at least two training sessions with 15-20 teachers involved. Sometimes principals and school counsellors also come to get necessary information about the programme (before they decide to start implementing it). Then further implementation depends on whether those teachers have the needed support from the principals and other teachers – we contact schools to inform them how important the work is that their teachers are willing to do and how they can support them.

It’s important to keep the contact with all teachers who decided to implement the programme. Also to organise meetings for them (in order to share their experiences, to share with them new things and information they want to hear, etc.).

With respect to social context

One very special cultural characteristic in Slovenia, which is holding back the progress in the field of prevention, is that people who are doing prevention have a negative attitude towards programmes originating from elsewhere even though they do not know the content of the programmes. They want to reinvent the wheel again and again and have been doing that for more than two decades. The only interest of key actors in the field of prevention is how to get more money for their "unique", mostly one-off activities and they do not care about the quality of it. Work is not conducted in a professional way. They agree that prevention is long term process but they often forget that "how you do it" also matters. What we learned with implementation of Unplugged is that we need to bring good practices to our schools, kindergartens, families etc., of course with some minor changes.

Teachers who are implementing the programmes report about “side”/”secondary” effects of the programme (teachers feel more comfortable in class, relationships among teachers and students and among students are better, some even reported fewer instances of aggressive behaviour). We decided to measure also these reported effects and hopefully we will scientifically prove them which will help with promotion of the programme (it would no longer be only “drug” prevention programme).

Strengths
The program can be effectively adapted to various contexts without losing effectiveness.
If a programme from elsewhere meets the needs of a certain community then it's reasonable to implement it (with adequate minor changes or adaptations). It takes a lot of effort and time to design and to test a new programme.
Programme with an instruction manual that can be easily used.
Weaknesses
The perception of the program as solely a "drug prevention" initiative limits interest among schools.Too long (12 lessons).
Opportunities

Prevention programmes are based on theories which can explain the risk factors for drug use. For example: according to the theory of social learning, individuals learn and develop their personality by observing the behaviour and actions of other people and the consequences of their actions. If for example particular American programme is based on social learning theory, this means that for example focus of the programme (among other focuses) is also in correcting misconceptions. This social influence theory is not characteristic only for people living in U.S. but for all people (we are talking about the human psychology in general). Especially in today's age of globalisation, we (in Europe) are subject to almost the same influences, regardless of where we live. Cultural differences (especially among young people) are now no longer so large and consideration is needed on whether to pay so much attention to cultural adaptation or in other words we shouldn't be so sceptical towards those programmes.

Recommendations

With respect to individual professionals

In every school there are some individuals who are willing to implement quality programmes. It takes time to find them, but once you “have them on board” it is more likely that programme will “live”. It is also important to take into account some other factors that influence the quality of implementation (teachers should have support whenever they need it; it is also important to organise special meetings for teachers who are implementing the programme in schools; etc.)

With respect to social context

Promote the program as a tool for improving classroom relationships rather than strictly for drug prevention.
Regular advocacy for quality prevention in order to “open the door” to a programme.
Contacting schools over and over again about Unplugged training.

With respect to organisational and economic context

  1. This programme should be supported by responsible authorities and professionals.
  2. It's important that implementers (e.g. teachers) are motivated, commited to their work and that they have professional support by National EU-Dap centre.
  3. It's necessary that all lessons are planned from the very beginning of school year, and to take into account that one lesson can be implemented in two school hours (one after another).
  4. Programme itself is relatively cheap for implementation. You only need funding for regular material printing (more you print less you pay), organisation of training, including fee for the trainer, and some coordination costs (e.g. coordinating staff, travel costs…). Comparing to some other “prevention” activities (e.g. one-off lectures or workshops) the cost for each school is much cheaper and they get structured and manualised programme for many years with no additional costs. In the case of national funding (like in our case) the cost for school is zero (free of any charge). At least on the basis of Slovenian experience with Unplugged the programme could be promoted as very cost effective intervention. And there is also no licence fee or regular (e.g. annual) licensing costs to developers etc. like in the case of some other evidence-based programmes.
Note from the authors

“Izštekani” - Unplugged

Number of implementations
1
Country
Slovenia
Feedback date
Contact details

Kelly Cathelijn
Kelly.cathelijn[a]fracarita.org
 

Main obstacles

With respect to individual professionals

Schools struggle to allocate time for the 12 lessons, as it is not part of the standard curriculum.

With respect to social context

The previous program was not tailored to specific target groups, particularly in vocational schools where students are more vulnerable to addiction. The program’s theoretical focus prompted a need for revision.

With respect to organisational and economic context

We have seen that, while schools are interested in working with ‘Unplugged’, the cost of the programme is an obstacle.

How they overcame the obstacles

With respect to individual professionals

We suggest:
1. Six lessons in the first year and six lessons in the second year.
2. Dividing the lessons among several teachers so that each teacher gives one or two lessons in their course.
3. An extracurricular day in which the lessons are implemented.

With respect to social context

We added more collaborative exercises tailored to target groups.

With respect to organisational and economic context

We sought out local community and service clubs (e.g. Rotarians) to support the schools.

Lessons learnt

With respect to individual professionals

During the training we offer various implementation methods.

With respect to social context

A differentiated strategy is essential in drug prevention to effectively reach multiple target groups.

With respect to organisational and economic context

Networking is essential for engaging multiple partners in drug prevention.

Strengths
  1. We provide a lot of exercises, so that teachers can choose which exercise is most appropriate for their class.
  2. The quality of the training is appreciated by 90 % of the teachers.
  3. The brand ‘Unplugged’ is well known in Flanders.
Weaknesses
  1. The cost of the programme.
  2. Schools can’t always find the time to implement the programme in an already full curriculum.
  3. Not all teachers are allowed to attend training sessions because of practical issues in schools.
Opportunities
  1. In some regions of Flanders we haven’t reached all schools.
  2. A lot of schools struggle with digital addiction (gaming, smartphones, tablets, etc.).
  3. Local communities feel the need for an effective drug prevention programme.
Threats
  1. School budgets are continuously under pressure.
  2. Schools are expected to deal with a lot of social problems (bullying, health, etc.). However, schools can’t solve all these problems.
Recommendations

With respect to individual professionals

Ensure that multiple partners are engaged in drug prevention efforts.

With respect to social context

Make sure the programme is implemented following a differentiated strategy to reach different target groups.

With respect to organisational and economic context

Work together with the local networks and schools.

Number of implementations
1
Country
Belgium
Feedback date
Main obstacles

With respect individual professionals

The main obstacle was adjusting the content of the information to the specific needs of the country. Another obstacle was adapting the role-play exercises so that all the targets for each lesson could be reached within one hour.

With respect to social context

Some people are reluctant to see drug prevention programmes implemented in schools.

With respect to organisational and economic context

The costs of the materials were quite high, and since our target was to implement the programme in as many schools as possible (at least two in each of the six districts of Bucharest and in each of the 41 counties of Romania), finding resources for these materials is quite a challenge.

How they overcame the obstacles

With respect to individual professionals

All the materials were adapted based on our national drug use surveys.

With respect to social context

Since Unplugged is a programme that develops life skills in order to prevent young people starting to use drugs, it was easy to change that mentality through parents’ meetings, media activities and focus groups in schools.

With respect to organisational and economic context

We managed to secure governmental resources in order to apply our national drug prevention policies. The Romanian Government considers the fight against illicit drug trafficking and abuse a priority and as a result we were able to reach our target in implementing Unplugged.

Strengths

Content and materials are comprehensive, well-organized, adapted, and practical.

Weaknesses

The costs of printing and the challenges of selecting and developing a network of trained teachers that can implement Unplugged.

Opportunities

Selecting and developing a network of trained teachers that can implement Unplugged.

Threats

Program quality may decline as more classes aim to implement Unplugged.

Recommendations

With respect to individual professionals

Carefully select the professionals who will implement the programme.

With respect to social context

Adapt the materials to the level of knowledge of the beneficiaries.

With respect to organisational and economic context

Unplugged should be implemented with no compromises on the aspects of quality printing and materials.

Number of implementations
1
Country
Romania
Feedback date
Contact details

Serena Vadrucci
serena.vadrucci[a]aslcittaditorino.it

Main obstacles

With respect individual professionals

  • Selection of teachers to be trained and to implement the programme.
  • Involvement of only one teacher per school.
  • Teachers are generally used to working alone, and their team-working attitude can be low.
  • Skill-based units are easily skipped, or implemented with limited interactivity.
  • The programme is ten years old. There are no media activities.
  • Motivation of teachers decreasing year by year.

With respect to social context

  • Schools and teachers with a low socio-economic context can be more difficult to involve.
  • Schools can have difficulties in printing Unplugged materials.
  • Schools can have difficulties paying for the teacher training and for the travel of the teachers to the training location.

With respect to organisational and economic context

  • Organisation of calendar for implementation of the 12 units.
  • Time-consuming programme.
How they overcame the obstacles

With respect individual professionals

  • Criteria for choosing teachers to be trained were shared, discussed and recommended with/to the school principals.
  • When organising the teachers’ training, the participation of at least two teachers per school was encouraged.
  • Unplugged trainers promoted a team-working attitude during the teacher training.
  • During teacher training, the importance of the implementation of skill-based units was underlined.
  • All skill-based units were implemented during teacher training.
  • An update of the original Unplugged material was organised, involving the most active teachers and trainers. Content on drug information and media activities were added, some role play stories and other specific situations were revised. New energisers were created.
  • Booster sessions for teachers were organised each year.
  • The very motivated and enthusiastic teachers were involved in teacher training and booster sessions as "testimonials".
  • Unplugged trainers were proactive in supporting and constantly supervising teachers during the school year, and engaging in a relationship based on reciprocal confidence.

With respect to social context

  • Presentations of the programme to schools with a low socio-economic context and meetings with principals and health educators were organised.
  • Unplugged materials were printed by the regional authority or by the local health office and distributed free of charge to schools.
  • Teacher training was free of charge.
  • Teacher training was organised in the city of the schools involved.

With respect to organisational and economic context

  • Calendar for implementation was carefully decided at the beginning of the school year and re-evaluated at regular intervals, possibly every month.
  • Calendar was decided together with school manager and non-Unplugged teachers of the class.
  • Process monitoring tools are useful to monitor the implementation: these tools were presented and distributed to the teachers during teacher training.
  • Splitting the 12 units across two school years: 6 implemented in the first year and 6 implemented in the second year.
  • Sharing/separating the implementation of the 12 units with another Unplugged teacher.
Lessons learnt

With respect individual professionals

  • It is very important that the teacher is interested in the programme; teachers not well motivated won't implement the programme.
  • Creation of an Unplugged teachers group within the school improves implementation and motivation.
  • During teacher training, working in groups is needed.
  • The importance of implementation of skill-based units must be underlined in teacher training.
  • Booster sessions help to maintain interest. Booster sessions should include the presentation of new scientific results (learning) and sessions dedicated to exchange of experiences between teachers (exchange).
  • Trainers must be proactive in contacts with the teachers.
  • Trainers and teachers must be involved in the revision of the material.

With respect to social context

  • Individual meetings with schools are needed.
  • Specific funding for printing Unplugged materials is needed. Better organisation of teacher training is needed.
  • Location of teacher training must take into account availability of teachers to travel.

With respect to organisational and economic context

  • The results of process evaluation – including implementation of the units and satisfaction of teachers and students about the programme – must be reported and given back to teachers in order for them to change organisation of implementation where needed and increase quality of implementation year by year.
  • A certain level of adaptation of the main standardised model of implementation and some flexibility in allowed changes are needed to ensure the highest implementation rate.
Strengths

Effective programme (evaluated). Standardised teacher handbook. Group of people dedicated to the dissemination (coordination centre). Network of trainers and teachers. Booster sessions for trainers and teachers. Collaboration of regional and local authority. Occasions for teachers to improve teaching. Materials and training at no cost for schools and teachers. Nice materials for pupils.

Weaknesses

Time consuming programme (12 units). Programme is ten years old. Media activities and related contents need to be updated. Dissemination is dependent on continuous funding. Lack of collaboration of local authorities. Competition with other similar programmes.

Opportunities

Networking. Group working. Involvement of teachers in the process. Interest of students. Universal programme. Wide autonomy of schools in choosing programmes. Occasion to promote evidence-based approach.

Threats

Decrease of motivation. Lack of funding. Conflicts among trainers. Slow production of scientific results.  Programme is ten years old. Wide autonomy of schools in choosing programmes: competition with other (non-evaluated) programmes.

Recommendations

With respect individual professionals

  • Special care must be applied in selecting teachers for training and implementation of the programme.
  • Booster sessions should be organised.
  • Create a network for teachers to exchange experiences and be part of the programme.
  • Be proactive in the involvement and supervision of schools and teachers.
  • Constantly promote the alliance of school and health sectors.

With respect to social context

  • Special care must be applied with low socio-economic context schools.
  • Funding for materials and training must be obtained.

With respect to organisational and economic context

  • Process monitoring tools must be provided, collected, analysed and reported.
  • Some flexibility in allowing changes in the model of implementation is needed.
Number of implementations
1
Country
Italy
Feedback date
Contact details

Kathrin Schütte
Landkreis Emsland
Kathrin.schuette[a]emsland.de

Rainer Lüker
Albert-Trautmann-Schule Werlte
rainer.lueker[a]ats-werlte.de

Main obstacles

With respect individual professionals

The different occupational groups approach the topic differently; here a common path had to be found.

With respect to social context

The different schools (special school, high school, etc.) had very different levels of performance

With respect to organisational and economic context

  • From a purely organisational point of view, it has sometimes been difficult to encourage exchanges and motivate professionals. All the professionals have implemented UNPLUGGED as part of their normal job and were not hired specifically for it.
  • There were no financial barriers for the time being, as UNPLUGGED was introduced under Communities That Care and it was considered useful and necessary by the political representatives.
How they overcame the obstacles

With respect individual professionals

Joint training of different professionals and constant exchange of information.

With respect to social context

In cooperation with the specialists, the programme was adapted to the performance level of the different schools.

With respect to organisational and economic context

As a "coordinator" always be approachable and try to motivate the professionals.

Lessons learnt

With respect individual professionals

For the success of the programme "UNPLUGGED" a constant exchange of information and networking are very important.

With respect to social context

Exchanges with professionals, on such topics as understanding and patience, were particularly important, especially for the weaker students.

With respect to organisational and economic context

Provide transparency to professionals, financial donors and decision-makers.

Strengths
  • Many professionals as multipliers who work together profitably through their different approaches.
  • Secure financing.
  • A versatile programme that fully informs students, not only on addictive substances but also on the topics "strengthening your personality" and "self-esteem".
Weaknesses
  • Many professionals who need to be motivated and who work very differently.
  • Partly complicated substance or expressed in a complicated way.
Opportunities
  • Different approach and different perspectives.
  • Very versatile and extensive programme.
Threats
  • Loss of motivation of the various skilled workers, since success cannot be measured immediately with this programme
Recommendations

With respect individual professionals

Different professional groups often work together profitably. The exchange must then be promoted and demanded from the outside.

With respect to social context

Exchange between and motivation of the specialists should be in the foreground. It is only through them that the programme can be implemented effectively.

With respect to organisational and economic context

  • The financing should be secure for a longer period of time (several years).
  • Regular exchange meetings must be carried out.
Number of implementations
1
Country
Germany
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