Spain

With respect to individual professionals

About 12 % of teachers say that they have difficulties in dealing with the programme’s interactive methodologies in class. Several follow-up studies have also demonstrated the difficulty that some teachers have in maintaining ‘active neutrality’ (that is, ensuring that their opinion, for example in favour of or against consumption, does not manifest itself).
It is also important to note, as with many programmes, that over the years teachers become less motivated to continue with the programme if there is not adequate support.

With respect to social context

The programme is generally well accepted by teachers, schools and families. The problem usually relates to how to ensure the continued support of the educational leaders of the municipality or region in which the programme is intended to be implemented. Although it is not an expensive programme to implement, there are sometimes other programmes already in operation or it is thought that it is better to have a portfolio of many programmes instead of only programmes that are proven to be effective.

With respect to organisational and economic context

The programme is free. Therefore, problems linked to economic issues are minor, but some costs are inevitable, for training, materials and the monitoring of the teachers who implement the programme. Problems are not usually encountered at the beginning, when the programme is launched, but after a few years. At this time, there is a tendency to decrease both organisational and economic efforts.

In any case, a large organisational structure is not required for the development of the programme.

With respect to individual professionals

• A wide range of other activities and programmes to be carried out with the students.
• Finding time to develop the programme. The large number of sessions.
• Large groups (25 students) or small groups in rural areas (six students) that make it difficult to address some topics.
• Difficulty of implementing the programme for students with special needs.
• Lack of student interest in the subject of prevention.
• Lack of training to deliver skills training (emotional control, self-esteem, assertiveness, peer pressure, decision-making, communication, etc.).
• Lack of experience with interactive methodologies and difficulties in managing groups.
• The fear of dealing with information about substances and not knowing how to answer questions or doubts.
• Poorly updated audiovisual materials.
• Lack of recognition by the administration of the work involved in the development of the programme.

With respect to social context

• The community does not demand or support evidence-based, school-based prevention programmes.
•  The community and its organisations believe that there are simpler ways to approach prevention, but do not have an evidence base.
• The community does not see the programme as a positive element. Sometimes it is not considered a necessity to believe that we have consumption problems.
• Lack of continuity of the programme in schools as a result of:
  • limited involvement of 1st and 2nd year secondary education teachers. In many cases it is done in isolated classrooms  and is only due to an individual’s motivation;
  • a large turnover of teaching staff in rural areas.
• Preferences for other topics by the educational administration and school principals, which often respond to ‘social fashions’ or issues that are the focus of media attention.
• The schools are committed to specific, simple, striking and less demanding activities for them.
• Extensive geographical zones, which limit the training due to the travelling involved.
• Lack of any kind of official recognition by the school.
• In some schools there are difficulties in the connection and involvement of families.

With respect to organisational and economic context

• Little support from the education system as a priority programme that adequately motivates teachers to be involved.
• The structured nature of the programme and the need for its fidelity generates resistance in the educational milieu, as they are programmes that do not originate from these stakeholders.
• The need to adapt to the changing reality of drugs (advertising, promotion, fake news).
• The lack of resources to update the manual (design and printing, digital format), and other audiovisual complementary materials.
• The reduced number of hours of tutoring in the organisational area in which the programme is developed.

With respect to individual professionals

• In the initial stages of the Lombardy project, health professionals found it difficult to accept the restrictions and adhere to procedures defined by someone else, and they were unsure of both their role in the LifeSkills Training (LST) project and whether the LST programme met the needs of teachers.
• Teachers had some concerns because they were worried that the programme was not appropriate for their students.
• Teachers were not accustomed to implementing structured classroom activities with high fidelity, and were more used to choosing all aspects of their teaching completely autonomously.
• Teachers had difficulties in implementing a classroom programme that used interactive methods and had multiple sessions, including booster sessions, over a period of several school years. The professional training of educators in Italy focuses largely on specific subject matter and less so on teaching methods. Most teachers in Italy have little experience with cooperative learning and interactive teaching methods. Typically, teachers provide lectures to students and are not familiar with teaching methods that involve facilitated classroom discussions or that provide the opportunity for students to practise new skills

With respect to social context

•The school context in Italy is very fragmented: teachers are often isolated, they do not typically work in teams, and principals often have difficulty in managing teachers. Moreover, schools do not often credit teachers for their work in health promotion; there is a high turnover of teachers; and schools have to face increasingly complex situations, such as the ongoing influx of foreign students. These problems were accentuated by the lack of and squandering of resources.
•The educational standards of Italian school systems are focused on liberal arts and philosophy, and lectures and speculative methods are highly valued.
•Prevention and health promotion are not explicitly included in Italian educational standards and the school curriculum.
•Italian teachers place a high value on autonomy and report high levels of satisfaction in their ability to act independently when choosing their method or style of working and teaching.
•Prevention programmes in Italy are typically not as highly structured and prescriptive as the LST programme. Very few programmes use manuals and lists of activities; instead, in practice, they typically involve a series of relatively unstructured discussion points for teachers to incorporate into their lessons.
•The prevention approach is highly influenced by ideological issues, and it is difficult to value the professional and pragmatic point of view in some cases.
•The strong role of families and their values makes it more difficult for schools to have a role in health promotion and prevention.
•There is a different alcohol culture in Italy from that in the USA, where the programme comes from. Italy belongs to the so-called ‘Mediterranean drinking culture’ (or ‘wet drinking culture’), in which moderate alcohol consumption (particularly wine) is considered normal and is part of daily life and family meals. For example, children are often given diluted wine with meals, and the perception is that there are few psychosocial problems regarding alcohol misuse.

With respect to organisational and economic context

• Differences among cities regarding prevention activities.
• Diffusion of many prevention activities without evidence of their effectiveness.
• Squandering of resources.
• Schools’ requests for ineffective activities (e.g. testimonials, talks from experts).
• Increasing levels of inequality.
• A health-promoting schools network has been established just recently, and it provides a fundamental framework for evidence-based programmes.
• The school organisation is fragmented: primary school is focused on educational goals, middle school is a grey area and secondary school is focused on subject goals.

With respect to individual professionals

• Initially, commissioners struggled with the American version of the programme and would not consider implementing the programme until a UK adaptation was complete. Other obstacles included a lack of understanding of social and emotional learning programmes within the school setting — no one wanted to take ownership of or responsibility for whether it was health or education. Individuals could not understand that, if we improve children's social competence, this will improve a range of outcomes for children including health and education.
• Teachers are under so much pressure within the school setting that they initially saw the programme as extra work and not as a way to make life within their classroom easier.

With respect to social context

• Schools across the regions having varying budgets, with some schools having no money to implement programmes
• Variations in the programmes implemented across the regions and a lot of schools taking on free non-evidence-based programmes when they were not necessarily the right programmes to be implementing in their schools — no outcomes
• No guidelines for schools on what to implement
• Lack of understanding of evidence-based programmes within health and education departments
• Personal development being mandatory within education systems, but there being no accountability regarding whether schools complete it
• No recognition for the importance of this type of work, which is academic focused

With respect to organisational and economic context

• Northern Ireland has no government, so school budgets have been frozen.
• Social and emotional programmes such as LifeSkills benefits are cross-cutting, which is to their detriment, as no department wants to take responsibility for it.

With respect to individual professionals

There were three obstacles:

1. Teachers did not always have enough time to follow the training and deliver the programme.
2. Another obstacle was the continuity; the programme is not a structural part of the curriculum.
3. We, as developers and researchers, are always dependent on grants.

With respect to social context

We developed a programme for all groups. This was a challenge, because everyone has to recognise themselves in the programme. The teachers received training in which they were able to practise this.

With respect to organisational and economic context

In high schools, only a few teachers follow the training and deliver the programme. An obstacle is that not everyone in the school knows about the programme and that management does not always support the practical conditions, such as providing a classroom and time to deliver the programme, and time for preparation.

With respect to individual professionals

The main obstacles for professionals are related to the selection, recruitment and retention of participants and their training of professionals for this purpose. Protego is a selective family prevention programme (aimed mainly at parents lacking skills required to manage challenges and difficulties related to their children’s education). This means that a large proportion of the target population that may benefit from participation in the programme is unaware of the benefits that it can bring and is often reluctant to participate. Therefore, the professionals in charge of recruiting participants (usually social service professionals) must manage such resistance. In addition, these professionals sometimes also have difficulty in determining whether or not an individual meets the requirements for inclusion in the programme or, by contrast, presents criteria for exclusion from participation in the programme.

With respect to social context

The main difficulties are related to some of the characteristics of the people to whom the programme is addressed: external locus of control, low awareness of need and/or low level of commitment to the education of children. In addition, participants also often have difficulties finding care for their children during the programme sessions and it can be difficult finding suitable times for parental participation.

With respect to organisational and economic context

Protego is a selective prevention programme aimed at parents with a low level of commitment to their children’s education and/or with few educational skills and who face difficulties related to family management. This, in addition to the fact that recruitment is usually done through social services, means that potential participants often have a low or very low socioeconomic status. This can sometimes lead to difficulties in attending programme sessions, especially for people living in rural areas and/or in remote areas that are poorly connected to the place where programme sessions are held (due to transport difficulties or cost). The working conditions of these people can also be an obstacle, since often, if they have a job, they have to work variable or unpredictable shifts.

Other obstacles may stem from a lack of interest and/or real political commitment to investing efforts in a programme such as this, which, while proven to be effective, requires significant effort and resources and is targeted at, by their very nature and needs, small groups, as opposed to being a universal prevention intervention.

With respect to individual professionals

The main obstacles are/were time, money and schedules. There are working schedules and the Equip Program has to fit somewhere into the schedule of the institution. Then we had/have to train people to work with the programme. So where in the schedule can you find time to train people as they also have to work? There is almost no time (or money) to let them go to training and so on. I think the picture is clear.

With respect to social context

I do not have a problem with the individual professionals. Mostly the problems come from the organisation, time/money problems or lack of good leadership.

With respect to organisational and economic context

Well, I think I can repeat myself here: the biggest problems are mostly the managers who did not take the Equip Program and all the implementation needs seriously. The professionals mostly were/are very positive about it. The neighbourhood and social system were also mostly positive. Sometimes we would have extra meetings for parents or the young clients’ social-care professionals.

With respect to individual professionals

The programme is implemented by teachers, with the support of health professionals from the Agència de Salut Pública de Barcelona (the Public Health Agency of Barcelona (ASPB)) for resources and training.
The main obstacle is the lack of training in and awareness of teaching professionals with regard to the importance of smoking and alcohol consumption prevention among young people.

With respect to social context

The main obstacle until now has been that the implementation of health promotion programmes in school is not mandatory for schools.
Second, being the oldest programme offered by the ASPB, we have observed a certain difficulty in maintaining the interest of schools that have previously been regular participants.
Third, as it is a programme that, above all, addresses smoking prevention, and smoking has decreased over recent years among young Spaniards, schools believe that the programme is no longer necessary.

With respect to organisational and economic context

The main obstacle is that the programme has to compete with other preventive programmes, and also other proposals from other companies and bodies, which in most cases have not been evaluated.
In addition, many of these offers are made with the proposal that the intervention be carried out by a health professional, supplanting the teacher.

With respect to individual professionals

Unplugged is implemented by teachers after they are trained, but teachers are not familiar with group work and interactive learning methods, and also they are not always motivated to use these methods in class.

With respect to social context

The school often does not provide the time and the space needed in order to implement prevention programmes like Unplugged. It is not a part of the school curriculum and it depends mostly on the willingness of teachers in order to be implemented.

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.

With respect to individual professionals

The lack of training of secondary school teachers in content relevant to the development of the programme, 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

As a consequence of the economic crisis that is still felt in Spain, it is very difficult to find sufficient economic support for the development of programmes like Unplugged.

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 a good deal of variation in programmes, pedagogy, etc. In order to implement a school programme this variation has to be taken into account.

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.

With respect to individual professionals

School-based prevention specialists who are trained get along with the intervention well.
We have little to no information on how the intervention is being implemented by class teachers.

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.

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).

With respect to individual professionals

Schools find it difficult to find the time to implement the 12 lessons.
It is not a part of their normal curriculum.

With respect to social context

In the past we have seen that the previous programme wasn't tailored to target groups.
In vocational schools we see that the pupils are more vulnerable to addiction.
Our programme was too theoretical, so we were inclined to redraft it.

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.

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.

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.

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.

With respect to individual professionals

The programme is implemented by teachers, with the support of health professionals of the Agencia de Salut Pública de Barcelona (ASPB) (Public Health Agency, Barcelona) for resources and training. The main obstacle is the lack of training and awareness of teaching professionals about the importance of the issue of alcohol and cannabis consumption among young people. On the other hand cannabis preventive messages have to be believable for young people, making the editing of this course much more complicated.

With respect to social context

The main obstacle until now is that the implementation of health promotion programmes in the school is not mandatory for schools. On the other hand, the social image of cannabis in our environment is very tolerant and very accessible, with the acceptance of false beliefs about its value as a herb with relaxing properties. Also the social image of alcohol as a necessary tool for celebrations is very present among adolescents, and even more, their aspiration to use it as a means to disinhibit themselves in leisure places.

With respect to organisational and economic context

Beyond the loyalised schools (35%), in the rest of the schools the decision to participate in the programme is threatened by the instability of the teaching staff, by the competition with other offers on drug addiction programmes and the great competition of extracurricular activities.