73% of European Countries require alcohol prevention in school

The World Health Organisation in Europe report that 73% of European countries have a legal obligation to include alcohol prevention in the school curriculum and just over half have national guidelines for the prevention and reduction of alcohol-related harm in school settings.

As readers of my last post will know England, unfortunately, won’t be part of that majority that require school based alcohol prevention.  This despite the fact that the country comes 9th for early drunkenness according to the Health Behaviours in School-age Children report.

But they can however point to NICE guidance on interventions in schools to prevent and reduce alcohol use among children and young people.

I can’t help noticing that the NICE guidance was produced in November 2007 and is due to be reviewed again next year.

One can only hope that it doesn’t suffer the fate of the guidance on sex and relationships education and alcohol which has been in suspended animation for the last three years.

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PQ: how much time do schools spend on drug education?

Conservative MP Nick de Bois asks the Department of Education what estimate they has made of the time schools dedicate to teaching students about the risks associated with (a) illegal drugs, (b) prescription drugs and (c) legal highs.

Liz Truss, the Minister with responsibility for these issues, responds:

The Department does not estimate the amount of teaching time schools dedicate to teaching about illegal or prescription drugs, or legal highs.

All pupils should be educated about the dangers and effects of drugs, and drug education forms part of national curriculum for science. This ensures that pupils are taught about the effects of drugs on behaviour, health and life processes. Provision in this area can be built on and extended through non-statutory personal, social, and health education (PSHE), should schools choose to do so.

Understanding the risks associated with drugs is an important part of young people’s education. To support this we launched the Alcohol and Drug Education Prevention Information Service (ADEPIS) on 13 April 2013, run by the charity Mentor UK, which provides high quality information and advice to practitioners, including teachers. The Department is also funding the Centre for Analysis of Youth Transitions (CAYT) up to March 2014. CAYT have set up an open-access data bank of quality assured impact studies on services and programmes that support the development of young people. The database will enable schools, commissioners and others to choose the best programmes with a strong evidence of impact.

While I’m sure this answer is accurate there are things they could have said that would have answered Mr de Bois’s question in a more straight forward way. Continue reading

How to Change Education from the Ground Up

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Recently I attend a talk by Sir Ken Robinson, it was focused on the current education system and how it should be changed to make it more suitable for the 21st century. I was drawn to this event for two reasons, one because of the big influence his previous RSA talk had on the London Youth Involvement Project during its middle phase.

Secondly it was the chance to look at the education system from a different point of view, we often focus on trying to change education from a national level but this talk was looking at how it should be built up from the ground up rather than a top down approach.

Sir Ken Robinson started by saying that the government is too focused on getting as many children into the top universities, this leads to confusion around intelligence and academic capability. This aspiration is false, we can’t all go to university and many people do not want to, it’s then drilled into you that if you don’t go to university you’re a waste. We should support young people to explore different aspirations at school not just ones that boost school league tables.

Due to the nature of politics, elected officials have a very short time to see change and often only care about what can be achieved in their terms of office. This means they can be quite resistant to change, so that is why it’s vital that WE do things differently so they follow us.

He also touched on the fact that we focus on STEM principles at school but this leaves other areas neglected and we should focus on Economics, Culture, Social and Participation. This really struck a chord with me as we often argue for a more rounded approach to education, especially in the drugs and alcohol field.

The main focus of the talk was the support and respect we need to give to teachers, if we empowering them and stop this system of ‘factory working’ for tests then we won’t waste all this potential of young people.

The quality of teaching and learning – that’s what matters, structure is much less important; central government is too focused on bureaucracy of schools and buildings rather than the quality of lessons.

I did not agree with everything that Sir Ken Robinson said but I thought it was an interesting take on education and I am fully supportive of the focus on quality of lessons. At Mentor we have focused on schools and teachers but maybe now is the time to build up a host of quality lessons on drugs and alcohol that we can deliver in schools.

What do we think about e-cigs?

2013-06-26 15.20.51A combination of a few real life experiences and an interesting twitter exchange has prompted me to try to write something about e-cigarettes.

Will Haydock says he may write something about this too, and if he does it’ll be fascinating to see where he gets to.

For me my thoughts turned to the issue a few weeks ago when I saw a report that suggested that a number of schools had explicitly banned e-cigarettes. Shortly afterwards my son came home from school saying that some of his classmates were experimenting with them in his secondary school.

I knew what I thought.

That it was a good thing that schools were taking action.  That young people using these things can’t be a good thing.

And then I thought again. Continue reading

Should drug education focus on drug use or drug abuse?

There’s an interesting looking paper in the Journal of Substance Use, I’ve only got access to the abstract, which argues that:

The persistent failure to differentiate use from abuse where currently illicit drugs are concerned undermines effective primary prevention of the addictive disorders we are really concerned with. Typical programmes have ignored this reality, which helps explain the failure of most drug education. Adolescents soon recognize the inaccuracies and exaggerations, which undermines the credibility of drug education and limits its effectiveness.

Without having read the whole article I’m clearly at a disadvantage, but I want to use the thesis as a jumping off point for a discussion of some of the complexities that drug education needs to grapple with. Continue reading

What does a public health response to drug prevention look like?

The debate on what a public health approach to drug policy looks like is not only happening here in the UK but is something that Americans are also looking at following the publication of the Obama Administration’s latest drug strategy.

This piece at the ever interesting Alcohol and Drugs History Society’s Points blog asks whether there’s any appetite in the public health community to ‘own’ the issue alongside the many other issues that they have traditionally addressed.  And it points out that public health measures can also mean:

fear-mongering and produce risk, blame and shame in their efforts, identifying “risky” lifestyles and behaviors. At its best, public health projects can address the complex etiology and interactions between individuals and their environments as well as focusing on the “upstream” societal factors—poverty and inequality, to name a couple—that are such important forces in determining one’s life chances.

This concern that drug policy could get lost is (broadly) the same point that Marcus Roberts from DrugScope makes here about the emergence of Public Health England and the local government’s budget decisions when it comes to determining local need.

The article on Points does however link to an attempt to map out what a public health approach may look like.  Developed by the New York Academy of Medicine and the Drug Policy Alliance the Blueprint for a Public Health and Safety Approach to Drug Policy sets out one way that New York might try to tackle issues around illegal drug use.

As you would expect the paper has sections that deal with prevention, treatment and the role of law enforcement.  Readers will I hope understand if I focus on the recommendations for prevention.

They are clear about what they see as prevention:

Effective prevention strategies enable people to make healthy choices and improve health outcomes for themselves and their families. Prevention can delay the initiation of drug use, avert the escalation of use, and diminish engagement in drug related activities that can lead to violence and/or criminal justice involvement. Prevention, here, is conceptualized both in its traditional sense of programs that provide education and skills to avoid or address drug use and, more broadly, to encompass community development strategies that address the root causes of drug use and offer individuals meaningful alternatives to drug use and drug dealing.

chart_1 (21)The first of their findings is that there is a desire to see more funding allocated to effective prevention initiatives.  The paper estimates that only 5.5% of the federal budget for drugs was spent on prevention work.  (It is worth noting that when the UK Focal Point estimated central government spending on drug policy here in the UK they were barely able to identify any spending at all.)

The paper argues:

Research shows that prevention programs can also be cost effective; for each dollar spent on prevention, communities can save up to $10 in drug treatment and counseling costs.  Too often, however, drug prevention programs are underfunded, narrowly defined, and operate in isolation, especially from other health promotion and community development efforts.

They are, however, keen to point out that what they are not calling for is solely investing in education and messaging (though they remain part of the mix) but to extend prevention to tackling the risk factors and building protective communities and environments in which young people can grow and which foster resilience.

The conception of a community prevention strategy is focused on the social determinants of health, particularly by reducing unemployment – which, for the authors, is also linked with providing alternative economic routes for those who may otherwise engage in drug dealing.

Youth Development

It is clear that the consultations that the authors did in drafting the report suggests that drug use by young people, and trying to prevent those harms was a significant issue for communities and professionals.

Prevention programming that facilitates positive youth development not only decreases drug use, but also reduces delinquency, violence, drop-outs, and teen pregnancy. Community members and academics highlight several risk factors for young people that needed to be better addressed in New York communities, including normalization of drug use and other problem behaviors by the media, peers, and, in some cases, parents; academic failure; family conflict; community disorganization; and lack of opportunities for positive involvement with family and community members.

The authors highlight the difficulty of providing positive out of school activities that focus on developing young people as a significant barrier to a good prevention strategy.

Drug education

The paper echoes our experience – see for example the youth led research we did for the London Youth Involvement project – that school drug education isn’t currently meeting the needs of young people.

Several participants, including young people, felt that current education strategies were nonexistent, under-resourced, or ineffective.

They are however able to report that nearly half (47%) of those who received prevention services got an evidence based programme; something we couldn’t claim.

The paper is clear that a a wide health education curriculum is part of what is needed:

According to research, a broad health based curriculum including drug education, along with life skills and decision-making training, can impact the choices young people make on a range of issues (drug use, gang involvement, violence, delinquency, teen pregnancy, etc.).

But the curriculum isn’t enough:

Schools were identified by community members as an important—but missed—opportunity to increase youth engagement, raise achievement expectations and outcomes, and more comprehensively address students’ needs in ways that can prevent drug use and drug dealing. Participants wanted schools to go beyond health education and do more to bolster positive youth development and academic achievement.

And what schools do should be allied to providing parents with the information and skills they need to be able to support school based drug education.

This draft strategy of building skills, supporting positive health behaviours and the protective factors that make risky behaviour less likely allied to a wider prevention push on the social determinants of health is very attractive to me and fits neatly with the UN’s recent prevention standards.  But it requires significant political will to make it happen, and that will be difficult to achieve in a period where resources are tighter than ever.

 

What can Google trends tell us about whether the news media drive interest in drugs?

There’s an interesting piece about whether media interest in ‘legal highs’ contributes to the likely use of those drugs over on the VICE website.

They take the recent story that the Mail in Sunday, and other news media, ran about the drug salvia being available on Amazon as a case study and say:

As soon as the article was published (in May 2013), Google searches for “salvia amazon” shot up astronomically. Whether any of those searches led to sales of salvia is impossible to tell, but the Mail’s piece generated a significant amount of publicity for the drug.

And they’re right as the graph below shows, there has been a spike of people searching Google using that term.

salvia amazon

It’s important to note that what Google are showing is relative interest rather than the absolute number of searches – so 100 represents the peak interest not that only 100 people searched.

What the Vice story doesn’t make clear is that it appears that almost all of the searches come from the USA, where I believe the Mail’s website has a very large following.

I thought it might be interesting to look at how these spikes, which I don’t doubt are caused by media interest, compare to other search terms.  

The first thing I did was remove the reference to Amazon and as you can see the spike disappears, dwarfed by events like the reporting on a celebrity’s apparent problems.

salvia

 

Then limiting the search to the UK, where once again interest in the life and reported troubles of a celeb led to the biggest search spike.

salvia uk

Then I added searches for other drugs and in the case of mephedrone added one of the nicknames used (‘meow meow’).

google searches

As you can see the level of interest – if we’re judging it by search terms – for ‘legal highs’ is much lower than for the more widely used drugs (cannabis and cocaine), but that the sustained media debate around the last government’s response to mephedrone did manage to raise interest in the drug to those levels for a short period.

As Vice note, what this data doesn’t tell us is anything about the motivation of those using the search terms.

The doctor will see you now…

Dr Who - Rooners Toy Photography

Perhaps because of our work on the Street Talk project, which looked to see whether youth workers could use an evidence based screening tool and Motivational Interviewing to reduce substance misuse, I’ve noticed a lot more about the use of brief interventions.

Quite a lot of what I’ve been hearing and reading about is focused on getting the health care system to take up and use brief interventions.  Whether that’s GPs or in Emergency Departments there seems to be a strong enough evidence base for using this approach, particularly with adults.

Up until today I’ve thought that this was unlikely to be an effective way of reaching young people, believing that they’re much less likely to us GP services in particular than adults.  But when I read this briefing from CADCA, an American organisation that helps to build community coalitions to prevent substance misuse, I thought I should check my assumptions. Continue reading

Barriers to Evidence-Based Education

Robert Slavin, director of the Center for Research and Reform in Education at Johns Hopkins University’s school of education, asks us to imagine that we used evidence to guide everything we do in schools and suggests:

educators would constantly look at their own outcomes and benchmark them against those of similar schools elsewhere. In areas that needed improvement, school leaders could easily identify proven, replicable programs. As part of the learning and adoption process, they would attend regional effective-methods fairs, send delegations to visit nearby schools using the programs, and view videos and websites to see what the programs looked like in operation.

He argues that there are there are four barriers to making this happen:

  • Too few rigorous evaluations of promising programs;
  • Inadequate dissemination of evidence of effectiveness;
  • A lack of incentives for localities to implement proven interventions; and
  • Insufficient technical assistance for implementing evidence-based interventions with fidelity.

Slavin is writing about the whole curriculum and indeed whole school interventions, but this seems to apply just as well to drug prevention.

He says that central government have a significant role in overcoming these barriers, not by determining which programmes to use but by:

  • Helping schools get better intelligence on proven programmes and persuading them that deploying them will lead to better outcomes.
  • Incentivising the take up of evidence based programmes through grant funding.
  • Supporting a variety organisations who can help local policy makers and school leaders learn about proven programmes.
  • Supporting organisations that can support the effective delivery of the programmes that schools choose to implement.

Read the whole article at Education Week: Overcoming Four Barriers to Evidence-Based Education.

What We Don’t Know about Evidence-based Programs

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Pertinent thoughts on the limitations of the evidence base we’re working with…

Interestingly, current replications of evidence-based programs place a priority on ensuring that the programs are being implemented with fidelity to the program model. This is done to help improve the chances that the program effects can be replicated in other settings. This is important, but we have missed an important step: If we don’t understand what it is about the program that made it effective in the first place, then it is challenging to replicate the effects that made the program desirable in the first place.

Read the rest on What We Don’t Know about Evidence-based Programs | Trend Lines.