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

EMCDDA analysis of implementing North American drug prevention programmes in Europe

The EMCDDA have been looking at whether prevention programmes that have been developed in North America (USA and Canada) could be delivered to effect in Europe.

The key points the EMCDDA identify are:

  • Cultural infeasibility is often seen as more of a barrier than it should be.  Where adaptations have struggled it may have more to do with low prevalence and high social protection than flaws in the programmes.
  • Adaptation needs care and consultation, but is feasible.
  • In adapting American programmes those doing so should consider culture and context separately.
  • Thinking about the social capital available may help reduce any anticipated resistance to programmes that have been developed elsewhere.
  • Adaptation needs to be careful not to change the key principles that have made the programme effective in the first place.  Changing illustrative examples to make them accessible to participants is fine, but changing the programme protocol (number and order of sessions, etc.) is likely to change the efficacy.
  • A considerable barrier to implementation may be the perceived complexity of the North American programmes – multi-component, multi-sessions, etc.

The paper gives examples of a number of the programmes that have had European trials many that will be familiar to readers of this blog – the Good Behaviour Game, Preventure, Strengthening Families Program, and Communities that Care.

From my point of view this is a very helpful resource with lots of great nuggets for any of us thinking about how we can introduce or replicate evidence based programmes that have been developed elsewhere.

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

How long before the government’s prevention fig leaves get blown away?

Fig leavesMentor has been quoted as part of a short debate on the Home Affairs Select Committee’s report on the government’s drug strategy.

Diana Johnson MP a Labour Party Home Affairs spokesperson, says:

Figures from Mentor, the drug and alcohol charity, show that at present 60% of schools deliver drug and alcohol education once a year or less. That education is often poor, incomplete or totally irrelevant; pupils aged 16 seem to get the same lessons as pupils aged 11. An example given was of sixth-form students being required to colour in pictures of ecstasy tablets as part of their drugs education. Earlier this year, Mentor told me:

“Drug and alcohol education should not be disregarded as a trivial add-on. It should be fundamental to pupils’ education. The links between early drug and alcohol use and both short and long term harms are clear, and there is compelling evidence showing longer term public health impacts of evidence based programmes. The cost benefit ratios are significant, ranging from 1:8 to 1:12.”

In terms of the wider debate there was a welcome focus on the role that prevention can play in reducing demand for drugs, but it is disappointing that all the Minister, Jeremy Browne, has to fall back on as concrete achievements of the drug strategy are the fig leaves of FRANK and the Choices Programme.

The evidence suggests that the FRANK website is unlikely to change behaviour on its own.  It may be that the helpline and other interactive services contribute to some preventative outcomes, but the Home Office have not (under successive government) undertaken or published any research on the behavioural impact of FRANK. Readers of this site will know that the EMCDDA recently recommended any mass media campaigns aimed at preventing drug use are accompanied by a robust evaluation. It is also worth noting that the budget for the services was been slashed to £500,000 last year suggesting that Ministers and officials don’t believe that it is an efficient way of spending money.

Mentor’s collaboration with Addaction on the Street Talk project was the largest single beneficiary of the Choices programme, so while we can be clear what we were able to achieve with the funding we also know that this was a one-off fund which allowed us to deliver the project for less than six months.  There has not been any suggestion from the Home Office that they will be continuing the programme.

It is also disappointing to see the Minister’s response on school based prevention, where he takes the line that good health education is somehow divorced from other educational entitlements.  Again readers of this site probably don’t need reminding of how interlinked risky behaviours and educational outcomes are.

If you are interested in reading the whole debate it can be found here.

PQ: Students, Ritalin and Modafinil

Conservative MP, Graham Brady, asks the Department of Health about what assessment the department has made on the misuse of Ritalin and Modafinil as cognitive enhancers, what they’re doing to restrict access, and inform students of the potential side effects.

The Minister answering, Norman Lamb, is on pretty solid ground when talking about the controls around the sale of these drugs – Ritalin is a Class B drug under the Misuse of Drugs Regulations, while Modafinil requires a prescription but isn’t controlled under the 1971 Misuse of Drugs Act.

He points out the restrictions around advertising Modafinil which apply to UK-based pharmacies, but admits these regulations don’t apply outside the UK, and goes on to say that the Medicines and Healthcare products Regulatory Agency (MHRA) have serious concerns about internet sales.

Lamb argues that there are regular warnings issued by the MHRA about buying medicinal drugs over the internet, and a quick look on the MHRA website turned up the a page on buying drugs off the internet and video which was uploaded to YouTube in December last year, since when it’s had 760 or so views.

The video, as you’ll see, takes a very traditional cautionary approach with a fictionalised account of a young adult needing emergency treatment because of his misuse of drugs bought from the internet.  At the end it advises viewers to visit www.RealDanger.co.uk which redirects to a Pfizer branded website, where interestingly there is a link to the same video, but this time on the Pfizer YouTube channel where it has had over 34,000 views.

The Pfizer site also links to a press release about a survey of pharmacists that suggests they think that internet sales of prescription drugs is rising, but doesn’t – as far as I can see – back this up with any data about the prevalence of misuse of medicines, or the number of hospital visits as a result of this.  They do however say that over the last 5 years the MHRA seized more than £34 million worth of medicine supplied illegally.

Of course what isn’t clear is how much of the seized medicines were the ones that caused Mr Brady to ask his question, nor on the prevalence of the misuse of these drugs, or whether the approach that Pfizer and the MHRA are taking is being successful in preventing further misuse.

Returning to the Minister’s response to the question, Mr Lamb, also comments on the role the national curriculum plays in informing younger students about drugs.  He rightly points out that the science curriculum has some broad words about teaching ‘the effects of drugs on behaviour, health and life processes’ and that this can be extended by PSHE teaching.

The prevalence of the misuse of medicines by school age pupils isn’t really measured by the Smoking, Drinking and Drug use survey.  They are able to show that 0.4% of pupils between 11 and 15 years said they took a Tranquilizer in the last year, as you’d expect they found that the proportions saying they’d used went up by age.

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I will need to check with Liz Fuller and her colleagues at NatCen that do the survey every year to check whether they ask about other medicines like Ritalin or other cognitive enhancers but certainly if they do the proportion is so small that they get gathered up in the ‘other’ category.

Recommendations for improving the capacity of public health in the UK

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A paper for the EU about the capacity of public health across the continent identifies the following as the recommendations for action:

  • Build competence across all sectors that can contribute to the health of the public within and beyond health care
  • Develop skills and knowledge (competences) in the wider workforce (i.e., those who make an impact on the population’s health through their role but would not necessarily call themselves public health workers e.g., teachers and urban planners. This workforce already exists and needs recognition and awareness-raising of their potential contribution
  • Improve information linking environmental factors and others (e.g., transport, planning) with health outcomes (e.g., to effect behavioural change) 
  • Ensure public health retains its influence across all sectors and at all levels by carrying out health impact analysis on all public policy; ensure that importance and relevance of public health is well understood by all sectors 
  • Strengthen multidisciplinary/multisectoral public health workforce that is adequately resourced to meet the needs of the population
  • Ensure adequate investments in health and well-being
  • Ensure that proposals for developing a new Public Health Service in England lead to enhancement of links with academia to expand capacity, and translate research into practice, and ensure that more undertaken research is informed by service needs
  • Additional research funding in areas such as evidence to support behaviour change

Intriguingly only the UK’s recommendations specifically talk about including teachers in terms of developing the wider workforce.

Anyway sounds like a good list to me.

School Connectedness: Strategies for Increasing Protective Factors Among Youth

school connectednessThis paper on school connectedness is from the Centers for Disease Control and Prevention in the US, but looks like it could be just as useful in a UK context.  It makes the link between the ways that schools can reduce the risk factors in their pupil’s lives and enhance the protective factors and how this can and should improve their health.

Efforts to improve child and adolescent health typically have featured interventions designed to address specific health risk behaviors, such as tobacco use, alcohol and drug use, violence, gang involvement, and early sexual initiation. However, results from a growing number of studies suggest that greater health impact might be achieved by also enhancing protective factors that help children and adolescents avoid multiple behaviors that place them at risk for adverse health and educational outcomes. Enhancing protective factors also might buffer children and adolescents from the potentially harmful effects of negative situations and events, such exposure to violence.

The paper suggests there are a number of factors that can increase school connectedness which they set out as:

  • Adult Support: School staff can dedicate their time, interest, attention, and emotional support to students.
  • Belonging to a Positive Peer Group: A stable network of peers can improve student perceptions of school.
  • Commitment to Education: Believing that school is important to their future, and perceiving that the adults in school are invested in their education, can get students engaged in their own learning and involved in school activities.
  • School Environment: The physical environment and psychosocial climate can set the stage for positive student perceptions of school.

This combination of a good curriculum (based in evidence) and the development of a school environment that protects young people will be at the heart of our new Alcohol and Drug Education and Prevention Information Service.

Prevention of teenage smoking through negative information giving

Some German research which looked at whether delivering negative information to young people about the effects of smoking has a preventative effect caught my eye.

In their abstract the authors conclude:

Although the clinic intervention generated a significant immediate reaction, there were no significant preventive effects at follow-up. These results are in line with previous research and add further evidence for the ineffectiveness of emotionally arousing negative information giving in smoking prevention with adolescents.

I’d be interested in whether this suggests that when NICE come to review their guidance on preventing the uptake of smoking by children and young people they will need to change their view that negative information should be part of smoking prevention information and campaigns for young people.

It has to be said that the German research contrasts with the findings of a review of health messages on tobacco products which found:

The evidence also indicates that comprehensive warnings are effective among youth and may help to prevent smoking initiation. Pictorial health warnings that elicit strong emotional reactions are significantly more effective.

The Cochrane review of mass media interventions for young people has some interesting observations on what makes for a successful campaign.  The reviewers say:

Overall, effective campaigns lasted longer with a minimum of three consecutive years, and were also more intense than less successful ones for both school based lessons (minimum eight lessons per grade) and media spots (minimum 4 weeks’ duration across multiple media channels with between 167 and 350 TV and radio spots). The timing and type of broadcast made a difference to their success, with older youths in one study preferring radio to television. Implementation of combined school based curriculum/components (i.e. school posters) and the use of repetitive media messages delivered via multiple channels (i.e. newspapers, radio, television) over a minimum period of three years contributed to successful campaigns. Changes in attitudes, knowledge or intention to smoke did not generally seem to affect the long-term success of the campaigns.

Meanwhile the recent update to the Cochrane review of school based prevention of smoking suggests that schools should combine social competence and social influences interventions.

School Health Services

I’ve been meaning to write about the contribution that school nurses can make to drug prevention and this report from WHO Europe from 2009 that I came across today has prompted me to at least point out some of the things we know.

Across Europe it appears that most school health services have some responsibility for substance misuse prevention.

school nurses

Cross referencing this with the PSHE mapping exercise carried out by researchers from Sheffield Hallam University a few years ago suggests that quite a lot of the drug and alcohol prevention activities that school nurses in England undertake are outside the classroom.  That review found that 17% of schools (both primary and secondary) used school nurses to deliver at least some of their drug education.

Health England when they looked at preventative spending in the NHS were able to show that of the £5 billion being spent on prevention and public health services in 2006/07 £159 million (3%) went to school health services.  They were able to split this down between primary (£44m) and secondary (£115m) prevention, and noted that £17 million could be attributed to the national Health Schools Programme.

Since then the government have issued a new vision for school health services, Getting it right for children, young people and families, which says:

School nurses will be part of teams providing ongoing additional services for vulnerable children, young people and families requiring longer term support for a range of special needs such as disadvantaged children, young people and families or those with a disability, those with mental health or substance mis-use problems and risk taking behaviours. School nursing services also form part of the high intensity multi-agency services for children, young people and families where there are child protection or safeguarding concerns.

There is a useful brief overview of this vision produced by the Department of Health and the LGA aimed at councillors, which can be downloaded here.

Also worth examining is the NICE guidance on school based interventions for alcohol, which makes the following recommendations (identifying school nurses as one of the groups who should take action):

  • alcohol education should be an integral part of the school curriculum and should be tailored for different age groups and different learning needs
  • a ‘whole school’ approach should be adopted, covering everything from policy development and the school environment to staff training and parents and pupils should be involved in developing and supporting this
  • where appropriate, children and young people who are thought to be drinking harmful amounts should be offered one-to-one advice or should be referred to an external service
  • schools should work with a range of local partners to support alcohol education in schools, ensure school interventions are integrated with community activities and to find ways to consult with families about initiatives to reduce alcohol use.

Finally below is a presentation that the Drug Education Forum had at one of the seminars we ran. It describes a multi-agency approach to improving health and wellbeing for young people in Bury, which included school health services.