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Principles Related to - College of Health and Human Services

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					Federal Funding to Support Research
  of Adventure Programming and
       Experiential Education:
     The Why’s and How To’s

           Aleta L. Meyer, Ph.D.
           Health Scientist Administrator
        (e.g, Program Official, Cheerleader)
            Prevention Research Branch
         National Institute on Drug Abuse
     Department of Health and Human Services
             #1
What is NIDA and what does it
  have to do with adventure
programming and experiential
         education?
   National Institutes of Health
                 (a sampling)

• National Cancer Institute (NCI)
• National Institute on Child and Human
  Development (NICHD)
• National Institute of Mental Health (NIMH)
• National Institute on Diabetes and
  Digestive and Kidney Disease (NIDDK)
• National Institute on Heart , Lung, and
  Blood Infections (NHLBI)
• National Institute of Drug Abuse (NIDA)
The Science of Addiction Brochure
• Office of Science Policy and Communication
  – Knowledge Transfer Goals
  – Draws from research done by all Divisions
• Research done through:
  –   Program Announcements (PA)
  –   Request for Proposals Announcements (RFA)
  –   Intramural Research
  –   Small Business Grants (SBIRs/STTRs)
• Walk Through Content à Application to Current
  World View
  Question: How and what is relevant to the work of
   adventure programming and experiential
   education?
Exercise that pre-frontal
        cortex!!
    DESPR Organization and Mission
                  EPIDEMIOLOGY RESEARCH BRANCH




                 DESPR promotes
            epidemiology, services and
              prevention research to
        understand and address the range
       of problems related to drug abuse, in
          order to improve public health.


PREVENTION RESEARCH BRANCH             SERVICES RESEARCH BRANCH
DESPR’s Vision is to Promote --

      Extraordinary
       Public Health
   Research to Eradicate
        Drug Abuse
DESPR: Major Research Questions

• THEORIES
  • What new theories inform our
    research?
• INTERACTIONS
  • What intrapersonal and environmental
    factors interact across development?
• BLENDING
  • How can we blend science and services
    to measurably impact public health
    outcomes?
         New Opportunities:

• New Theories
 Ø   Economics &
     organization/management
 Ø   Neurobehavioral disinhibition
 Ø   Measuring severity of drug
     addiction
 Ø   Geo-mapping drug abuse and
     risk factors
 Ø   Exercise and drug abuse
     prevention
      New Opportunities:


Interactions
  Ø Implementation
    science
  Ø Gene-environment-
    development studies
  Ø Built environment and
    individual factors
          New Opportunities:

• Science to Services
  Ø   Medical settings
      – Screening (especially SBIRTs)
      – Prescription drug abuse
        (especially opioids)
  Ø   HIV interventions among drug
      abusers
  Ø   Drug abuse services in criminal
      justice settings
Division of Epidemiology, Services
     and Prevention Research




Promoting Extraordinary Public
 Health Research to Eradicate
         Drug Abuse
                              #2
     Given what you know about adventure
   programming and experiential education….
….how could Extraordinary research that
  makes a difference happen without them??
• Core Experiential Learning Theory Assertions:
  – The actual behavior is elicited in context with real-
    life contingencies
     • Behavioral reinforcement is built-in to the activity
  – Effective use of metaphors promotes transfer across
    contexts
  – Learning styles of youth favor experiential
    strategies
                   #3
            The Time is Ripe!
• NIDA is investing in the development of a
  research portfolio that looks at potential role
  of physical activity, healthy leisure, outdoor
  adventure, and restorative recreation in the
  prevention of drug use
• SA Treatment and Physical Activity Science
  Meeting in December 2007
  – PA and relapse prevention
  – PA and healing of reward-pleasure circuitry
• Prevention Science Meeting June 5 & 6, 2008
Can Physical Activity and Exercise Prevent Drug Abuse?
Promoting a Full Range of Science to Inform Prevention
                      Draft Agenda
  • Welcome from NIDA
    – 3 Divisions and Why Physical Activity of Interest
  • Panel 1: Informing Drug Abuse Prevention
    Through Research on the Epidemiology and
    Etiology of Physical Activity and Substance Use
    – Physical Activity from Cells to Neighborhoods: Setting
      the Stage
    – The Physiology/Neurobiology of Physical Activity in
      Humans
    – Trends in Physical Activity, Substance Abuse, and the
      Interaction Between Them: Data from Monitoring the
      Future
                Draft Agenda Contd.

• Panel 2: Show and Tell of Technological
  Tools to Help Assess Physical Activity:
  Product Demonstrations
  – The Pros and Cons of Physical Activity
    Assessments: An Overview
  – Integrated Measurement System (IMS) to
    Assess Physical Activity
  – Population-Scale Physical Activity
    Measurement Using Mobile Phones
  – Geospatial Analysis of Physical Activity
  – Measuring the Restorative Character of Nature
    -Based Activity
                Draft Agenda Contd.

• Panel 3: The Potential Role of Physical
  Activity, Attention, and Other Cognitive
  Processes in Preventing Drug Abuse
  – Exercise and Attention Disorders
  – Physical Activity and Cognition Across the
    Lifespan
  – Motor and Physical Instructional Strategies for
    Young Children
  – Effectiveness of Social-Emotional Learning on
    Impulse Control
                          Draft Agenda Contd   .
• Panel 4: Physical Activity and Mood:
  Implications for Prevention
  – The Physiology/Neurobiology of Stress and Physical Activity in
    Animal Research
  – Exercise, Depression and Nicotine Treatment
  – Physical Activity and Prevention of Internalizing Disorders

• Panel 5: Physical Activity and Reward
  Mechanisms: A Model for Prevention
  Intervention Development
  – Exercise as an Alternative to Drug Seeking in Young
    Animals
  – The Effect of Enhanced Environment on Drug Seeking
    and Sensation Seeking Behavior
  – Experiential Approaches and Motivation
                   Draft Agenda Contd.

• Panel 6: Physical Activity in Prevention
  Interventions: Understanding the Context
  – Health Wise and Time Wise: Teaching Adolescents to
    Structure and Use Their Leisure Time
  – Creating Supports for Physical Activity in School
    Settings
  – School Environment and Obesity: The HEALTHY
    Study to Lower Diabetes Risk in Youth
  – School-Community Partnerships to Prevent
    Cardiovascular Disease and Obesity in Girls Through
    Physical Activity
  – Use of Public Spaces: Experiences of Diverse Ethnic
    Groups
• What Have We Learned and Next Steps?
                 #4
Lessons Learned in Moving Prevention
      Beyond Good Intentions
• Prevention Makes Sense BUT….
  – How do we know it works?
    • For whom, under what conditions, and when?
  – Not as provocative as treatment
    • Benefits not as concrete
    • Not crisis driven
  – How do we get people to spend scarce
    resources of time, energy, and money?
Creation of Prevention Research Branch and
Development of Research Portfolio (~1990)
• Investigator Initiated Research
  – Program Announcements for Preventive
    Interventions for Substance Abuse Prevention
     • R-01
     • R-21
     • R-03
  – Specific RFA’s with set-asides
  – Mentorship/Training (K-series; Diversity
    supplements)
  – FAST TRACK for new investigators
  – Small Business Grants (SBIRs/STTRs)
   Mission and Purpose of the
   Prevention Research Branch

• “…to support a developmentally grounded
  program of research on the prevention of
  the initiation of drug use, progression to
  abuse and dependence, and transmission
  of drug-related HIV infection.…” (p. 4)
                 Noteworthy Tidbits
• “To advance the field, novel interventions must
  build on basic science findings from diverse fields…”
  (p. 5)
• Universal, selected, and indicated
• Underdeveloped areas:
  –   Developmental transitions
  –   Differential effectiveness
  –   Fidelity of implementation
  –   Emerging technologies

• Question: What does adventure
  programming and experiential education do
  that is relevant to NIDA prevention research
  priorities?
             #5
 Going Beyond Best Practices
and Evidence-Based Programs


   PRINCIPLES OF
    PREVENTION
  Clearly Established Principles

• Arrived at from an extensive literature
  review of articles from NIDA funded
  research
• Reviewed by an expert scientific panel
• Reviewed by a professional practitioner
  panel
• Resulted in 18 principles
Principles Related to:

     Risk and Protective Factors
• Prevention programs should
   – enhance protective factors and reverse or
     reduce risk factors
   – address all forms of drug abuse, alone or in
     combination
   – Address the drug abuse problems of the local
     community by targeting modifiable risk factors
     and strengthening protective factors
   – Be tailored to address the risks specific to the
     target population
  Principles Related to:

              Prevention Planning
• Family programs should
  – Enhance family bonding, parenting skills, and
    communication


• School Programs should be specific to the
  developmental status of the children
  – Before/during the elementary school years: self control,
    emotional awareness, problem solving, communication &
    academic readiness/competence
  – Middle, junior high, and high school: peer relations,
    study habits and academic support, communication, self-
    efficacy and assertiveness, drug resistance skills
  Principles Related to:

              Prevention Planning
• Community Programs
  – Aimed at the general population during key transition points
    (e.g, moving to junior high) can be beneficial for those at all
    levels of risk
  – That combine 2 or more effective programs (e.g., school and
    family component) can be more effective than one program
  – When using multiple context to implement programs,
    policies and practices consistent messages should be
    presented across settings
  Principles Related to:

      Prevention Program Delivery
• When communities select programs to meet their
  needs, the implementation should retain the core
  elements of the original program
• Prevention is an on-going effort with repeated
  programming over time to reinforce earlier goals and
  develop new skills
• Teacher training in classroom management is a critical
  school-based prevention strategy
• Evidence based prevention interventions are cost
  effective
           Emerging Principles
• Preventive interventions can have long term
  effects
• Preventive interventions can have cross over
  effects
• Early intervention may alter the life course
  trajectory in a positive direction
• High risk populations may benefit the most from
  prevention interventions
• Prevention interventions can influence
  physiological functioning
• Drug abuse prevention can be HIV prevention
• Environment can be a natural intervention
Preventive Interventions Can
  Have Long Term Effects
Preventive Interventions Can
  Have Cross Over Effects
Early Intervention May Alter The
  Life Course Trajectory In A
        Positive Direction
High Risk Populations May
  Benefit The Most From
 Prevention Interventions
Prevention Interventions Can
   Influence Physiological
         Functioning
Drug Abuse Prevention Can
    Be HIV Prevention
Environment Can Be A
 Natural Intervention
                   #6
Expanding Our Understanding of Prevention,
   Health Promotion, and Positive Youth
              Development
• Moving Beyond
  – A focus on individuals
  – A focus on programs
  – Conceptual models based on early aggression
• Moving Toward
  – Health Promotion Across Domains
  – Positive Youth Development
  – Conceptual Models Based on New Science from the
    Micro to the Macro
  – Systems-Level Change
   Evidence-Based Kernels and
  Behavior Vaccines (Embry, 2004)
• Evidence-based kernels are irreducible units of behavior-change
  technology, and they can be put together into behavioral vaccines
  (daily practices) with powerful longitudinal results.
• Breadth of reach (self-directed, dyadic, group,
  community)
• Multi-level Approach
   –   Level   One – Cultural Modeling
   –   Level   Two – Brief Tools
   –   Level   Three – Narrow Focus Tools
   –   Level   Four – Broad Focus Tools
   –   Level   Five – Intensive Tools
    Related Paradigm Shifts

• Public Health Model vs. Medical Model
  – Curve Shifters


• Supply-Push vs. Demand-Pull

• Public Health Approach vs. Service
  Development Model
“If we spend so lavishly on medical care and
 we care so much about health, why are we
    so unhealthy?” (Cohen & Farley, 2005)

• A public health approach used to address
  preventable chronic diseases à Shifting the Curve
• A focus on environmental contexts that serve as
  cues or triggers for behaviors that are risks for
  health or are health promoting
  – Environments can be physical or social
• Example of heart disease
  – What aspects of our environment make it easy to do the
    things that put us at risk for heart disease?
                      Bell Curves
• Basic shape of bell curve
  – High and low ‘tails’ of extreme behavior
  – Mean or average in the middle (at the height of the
    curve)
• Example of eating salt
  – A medical approach would focus on changing ALL the
    unhealthy behaviors of people at the high end (in
    addition to medications)
     • A focus on getting rid of the tail at the right of the curve
  – A public health approach would focus on changing
    small behaviors of ALL people
     • A focus on shifting the mean of the curve to the left
         – This reduces level of risk for all
         – This moves the ‘extreme’ tail farther to the left, so even though
           the same number of people, they are at less risk
• Greater reduction of public health burden of
  heart disease when mean is shifted (than when
  efforts are focused on those at highest risk)
                Curve Shifters
• Curve shifters are changes in the physical and
  social environment that move the curve to the
  left
   – More sidewalks, mass transit
   – Time in schedule for taking a walk with family/friends
• Not surprisingly, changing the environment to
  support healthy behavior is easier said than
  done
• Even so, it is a powerful tool for thinking about
  how we can prevent youth violence and/or
  bullying
         Developing Effective Prevention
           Services for the Real World
                         (Sandler et al., 2005)

• Prevention Research Cycle
  –   Description of the problem
  –   Development of intervention
  –   Experimental test
  –   Experimental test in service setting
  –   Adoption and implementation

• Problems with this model (e.g., on-going
  services research)
  – Has not made a dent in prevalance at population
    level
  – Not being adopted / Sustainability issues
Prevention Service Development
             Model
• Service Marketing Perspective considers
  customer input at all stages (both ultimate client
  who is recipient and the agency that adopts)
• Front-end planning
  –   Organizational mission and goals?
  –   Idea generation
  –   Concept development
  –   Feasibility Analysis
• New Phases: Prototype Development and
  Testing; Introduction to the Market; Post
  Introduction Evaluation
     Small Business Approaches
• Small Business Innovation Research (SBIR) /
  Small Business Technology Transfer Research
  (STTR)
• Goal: Promote small businesses through innovation
  and technology, to “spread the news” about what
  works
• Small businesses create the applied possibilities,
  after Ivory Tower researchers create the concept
• Example: Evidence-based programs
  – Test on new populations and settings
  – Create marketing and implementation opportunities for
    greater use/dissemination
                    #7
  What are priority areas of hypothesis-
 testing for adventure programming and
          experiential education?

• Specific Areas of Research Interest (pp. 6-9)

• Question: What would the little ‘line items’
  be for adventure programming and
  experiential education look like?
  – WRITE THESE DOWN AND GET A COPY TO ME
             Food for Thought
• Testing Experiential Learning Approaches
  – Comparison of EBPs with and without EE
• Additive Effects à Use of metaphors/language
  from school-based prevention curriculum to
  field trips
• Diffuse Binge Drinking with Rites of Passage
• Teach parents how to facilitate ‘natural high’
  experiences to promote competence and
  transfer across settings (and over time)
  – E Sharp’s research on leisure guidance from parents
• Event-Affect Links
    – Social-Emotional-Information Processing
• Relational Frame Theory / Contextual
  Psychology
    – Move from belief we need to change beliefs or
      thoughts before behavior will change
    – Focus on function over form
    – Have you feet follow values, not thoughts
•   Positive Risk-Taking
•   Learning Orientation Toward Goals
•   Possible Selves / Willingness to Fail
•   Mindfulness
       REPEAT MESSAGE:

Get Readyà The Time is Ripe!!
 Final Question: How many people have
        said something like thisà
   “Opportunity favors the prepared…”
 Who were they and what did they say?
        Contact information
• meyera2@nida.nih.gov
• 301-402-1725

• Active Living Research Meeting April 9-11,
  2008, Washington DC

• Society for Prevention Research Meeting
  May 28-30, San Francisco CA

				
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