School alcohol policy can effect drinking – but only if pupils think it will be enforced

School rulesA few years ago the survey the government commission about school children in England’s smoking drinking and drug use stopped asking schools whether they had a drug and alcohol policy, they found that (almost) everyone did, but what hasn’t been clear is whether those policies are effective.

If you take exclusions as an indicator (and I’ll admit it might not be a very good one) the messages are a bit mixed as I discussed in more detail back this time last year.  Then it seemed that while permanent exclusions for drugs and alcohol had been falling and fixed term exclusions had remained roughly stable they had both been increasing as a proportion of the overall exclusion rates.

New research carried out looking at school alcohol policies in the US and Australia suggest that they key element is not in having a policy but in whether the pupils think it will be enforced.

According to the write up of the research on Science Daily:

even if a school had a suspension or expulsion policy, if students felt the school didn’t enforce it then they were more likely to drink on campus. But, even if a school’s policy was less harsh — such as requiring counseling — students were less likely to drink at school if they believed school officials would enforce it.

They other key finding they describe is that harm is reduced if pupils think that the likely result of being caught is that they get an intervention by a teacher on the dangers of alcohol use, rather than being excluded.

The ADEPIS toolkit for schools wanting to review their drug and alcohol policy published earlier this year may be a useful way of helping pupils get a better understanding of what the school’s policy is and a helpful reminder to the rest of the school community about what their response to incidents should be.

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.

School based programmes for smoking prevention

The Cochrane Collaboration have published a review into school based smoking prevention programmes, which updates a review of the evidence base from 2002.

The headline finding is that programmes that combine life skills and a focus on social influence seem to be the most successful, with those trials that were examined showing significant effect at one year and at the longest follow-up point.

Interestingly the review finds that a trials looking at using a social influence model on its own haven’t shown a significant effect, nor have programmes that seek to combine with interventions outside the classroom, or ones that rely on information provision alone. Continue reading

Chicken or Egg? Who cares, the link between health behaviours and educational outcomes are clear

This meta-analysis of 25 years of data from the US makes it very clear that there is an intimate relationship between health behaviours – including substance misuse – and academic achievement.

The paper (which is free to download) looks at the data for the following risky behaviours and educational outcomes:

  • violence;
  • tobacco use;
  • alcohol and other drug use;
  • sexual behaviours contributing to unintended pregnancy and sexually transmitted diseases;
  • inadequate physical activity; and
  • unhealthy dietary behaviours.

They conclude:

For all six health-risk behaviors, 96.6% of the studies reported statistically significant inverse relationships between health-risk behaviors and academic achievement.

Continue reading

Evidence-based programmes in schools: are they a realistic solution for drug and alcohol prevention?

On 26 March, Mentor will be hosting a seminar: ‘What works’ in supporting young people’s development – making evidence useful for schools and practitioners. Mentor is very supportive of the use of evidence-based programmes, but to say that their use in the UK for drug and alcohol prevention has been limited is an understatement.

There are different types of evidence (see the presentation below) but some of the strongest comes from randomised controlled trials (RCTs). Allocating randomly between the intervention and control groups makes it more likely that any improvement is due to the intervention and not some other factor. Continue reading

Effects of School-Wide Positive Behavioral Interventions and Supports

In the Good Behaviour Game (GBG) we’ve seen that providing classroom interventions which focus on general behaviour and attachment to school can have a positive effect on substance misuse later in life, so the research (described here) about the impact of school-wide positive behaviour interventions and support (SWPBIS) may also be of interest.

Probably the most positive finding that is reported is that pupils in intervention schools were 33% less likely to be sent to the school office for disciplinary reasons.  And as opposed to GBG, which had most effect on boys, SWPBIS appears to benefit girls but not boys in this respect.

They also showed that the earlier the interventions started the bigger the result.

Being bullied and risky behaviours

Research by NatCen shows that young people who are bullied at the age of 14 are more likely to have emotional health concerns, be misusing substances, and get in trouble with the police.

What wasn’t measured were the effects on out of school risky behaviours such as substance misuse, but another study looked the effect on bullying – something that has been shown to be a factor in substance misuse.  The researchers conclude:

The results indicated that SWPBIS has a significant effect on teachers’ reports of children’s involvement in bullying as victims and perpetrators.

What I notice when I looked at the website which details how SWPBIS works is that it has a process that is very similar to the Communities that Care; in that it isn’t based on prepared interventions.  Rather schools use the data they collect to determine their needs and are then given a range of evidence based interventions and programmes that they can choose from.

I also notice that the approach has been established by the Office of Special Education Programs, in the US Department of Education, and can’t help contrasting that with the lack of programme and intervention development by our own Department for Education.

From my point of view making the connections between the personal development opportunities for young people and the boundaries that schools and families put around children and adolescents feels critical if we’re to have a comprehensive prevention strategy.

Evaluation of In:tuition

Alcohol Research UK have published the process evaluation and feasibility study of In:tuition, DrinkAware’s life skills programme.

There are some very interesting observations.

On the positive side the teachers and pupils clearly see the programme as being useful and engaging.  The resources and tools were seen as being comprehensive and useful, and the flexibility around the on-line and off-line tools was also appreciated.

More challenging is that while the evaluators found that primary schools were more able to find the time to undertake the 10 lesson programme secondary schools really struggle.

Time for PSHE can be very limited and programmes crowded.  Five of the 15 schools, including the 3 schools that piloted all 11 secondary lessons, did so with a small targeted group of pupils, which offered more flexibility.  Of the 10 schools that piloted secondary lessons within their timetabled PSHE education programme none completed all the lessons and only 3 schools used most of them.

As you might imagine this is something of a challenge for those of us who believe in evidence based programmes – given that those that have shown longer term effects all come in at this sort of length or longer.

Another worry is the thought that there is some evidence that doing bits of programmes may have iatrogenic effects – i.e. lead young people to be more likely to drink or take drugs.

I also see that one of the recommendations from the evaluation is to reduce the length of the programme.  I think this is clearly something that meets the needs of schools, the question will be whether it would impact on the public health outcomes that DrinkAware are hoping the programme might have.

In search of feasible fidelity

In the University of York publication “Better Evidence-based Education: Evidence-based policy and practice”, David Andrews looks at the process required for evidence programmes to be adopted by schools. Commitment to fidelity is vital, so educators must assess whether this will be feasible for the intervention they are considering.

He urges educators thinking about adopting evidence-based approaches to weigh the costs and benefits for themselves. In particular he stresses that benefits need to be “practically significant” as well as “statistically significant”.

His list of the costs and benefits to be assessed includes the following:

Direct costs

  • How much do the materials cost, and do they duplicate other materials that need to be purchased?
  • How much does the training and ongoing support cost?
  • How much time will it require?
  • Will there be a need for additional personnel?

Indirect costs

  • How much teaching time will be required from personnel and pupils?
  • How much time will be expended in gaining teacher and staff support?
  • How much prep time should teachers expect outside the classroom? Are there hidden costs?
  • How much political capital will be expended in changing to a new approach?

Direct benefits

  • What are the academic gains expected?
  • What non-academic gains are expected, for example attendance, discipline, parent engagement or reduced academic disruptions?
  • Are there direct savings of teaching time?

Indirect benefits

  • What are the expected improvements in staff climate and morale?
  • What are the expected benefits in retaining teachers and staff?
  • What are the expected benefits from the general skill development of teachers?

He also states “Sustaining the adoption can be more difficult than choosing and getting started.” While it is important not to judge an intervention prematurely, and to allow sufficient time to gain results, if ‘early wins’ can be identified, these are crucial to maintaining teachers’ enthusiasm, and helping sustain the programme.

Another consideration for Mentor is that if schools are failing to adopt evidence-based interventions which have a direct impact on pupil learning and achievement , for example reading ability, there will be an additional challenge in getting them to adopt programmes where the main benefit (e.g. reduced alcohol consumption) is perceived to lie outside schools’ ‘core business’.

Teacher Says…

Paul and I visited the John Warner School in Hertfordshire this morning to talk to the headteacher about introducing evidence based programmes to schools.

The advice he gave was interesting.

In his view getting the right buy-in from the appropriate level in the management team was critical.  Of course at the headteacher level, but even more importantly getting the person who would manage the programme in the school, either an assistant headteacher or someone in the management team.

He argued that providing them with training in the programme – not so much the delivery, but the strategy, theory and outcomes – could be critical to success.  As was showing them how it could benefit their school and their own career.

Another tip was to provide training for the teachers that will be delivering the programme in the school itself.  Which he suggested will see higher take-up (including amongst non-teaching staff) and reduce costs.

Other points he made were not to pitch the programme as part of PSHE (which he felt was not well regarded by teachers), to only allude to meeting Ofsted’s outcomes, to provide ongoing feedback to the school, and use them as recruiting agents for future roll-out.

Finally, he also said that if there is to be a cost to schools then finding ways to provide discounts to early adopters would be useful in embedding the programme.

Interestingly, there was a very big cultural divide between the school and other local institutions in particular the council (‘too much money sticks to the sides’) and the health service (‘you get invited to a meeting only for it to be cancelled’).

Evidence, which interpretation is better..

Harry Egg by paulhurleyuk
Harry Egg, a photo by paulhurleyuk on Flickr.

The World Health Organisation have just published two report which have different very different interpretations of the state of prevention research.

Writing for the WHO about alcohol in the EU, Peter Anderson, Lars Møller and Gauden Galea have this to say about school-based programmes:

Many systematic reviews have evaluated school-based education and concluded that classroom-based education is not effective in reducing alcohol-related harm (Foxcroft et al., 2003; Jones et al., 2007).

They underplay the positive findings of a later Foxcroft meta review by pointing to the number of reviews that showed no effect, and that it was impossible to tell what the active ingredients were in the trials that did show effect.

So how to square that with the Health Behaviour in School Age Children report from the same organisation that found:

School-based intervention programmes focusing specifically on alcohol use and targeting adolescents and their parents have considerable effects. Generic, psychosocial and developmental, school-based prevention programmes focusing on life skills and a healthy lifestyle in general are also effective and could be considered as policy and practice options.

Last month writing in the Lancet Richard Catalano, director of the University of Washington’s Social Development Research Group said:

Prevention science and the effectiveness of prevention is one of the best-kept secrets in the world.

While the interpretation of the evidence is so wildly different as these WHO’s documents set out it is easy to see why it remains difficult to secure large scale investment in prevention programmes.