OVERVIEW OF EVIDENCE-BASED PROGRAMS
Levels of Effectiveness of Science-based Prevention: Level 1 programs have only anecdotal (subjective) evidence of positive results Examples: Testimonials, newspaper reports or non-refereed publications Level 2 programs have documented positive effects using qualitative data. Program outcomes have been recorded in conference reports, internal reports, published non-academic articles, etc. Examples: Program evaluations and source documents Level 3 programs use scientific methods that include pre-and post-testing with a comparison group to assess impact. Results are published in at least one scientific, peer-reviewed journal. Examples: Single trial effectiveness Level 4 programs are analyzed for effectiveness through meta-analysis or expert review. Results appear in refereed publications, dissertations, evaluation reports, and source documents. Examples: Meta-analysis, expert review, and peer consensus Level 5 program have been successfully replicated in several settings. They have been evaluated using scientific methods that include a pre and post-test to show positive results that are published in more than one scientific, peer-reviewed, academic journal. Examples: Multiple site replication studies Recommendation: In order to be considered an evidence-based program (EBP), a Level 3, 4 or 5 on the effectiveness scale must be achieved.
HIERARCHY OF PREVENTION EFFECTIVENESS
Highest Confidence Successful replication of the program in multiple communities Demonstrated program effectiveness in one community Positive preliminary outcomes but no rigorous evaluation Positive process evaluation results Positive results based on systematic observation of the program and its participants Anecdotal evidence suggesting program effectiveness
Lowest Confidence
Evidence-based programs rated by the National Registry for Effective Prevention Programs (NREPP) fall along a continuum of effectiveness, ranging from promising to model programs.
Promising programs have demonstrated some positive outcomes, but are either not consistent over time or the evaluation has not yet been rigorous enough to show consistency Effective programs have demonstrated a consistent pattern of positive outcomes Model programs have consistent outcomes and are readily available for dissemination, with technical
assistance available from program developers
* abstracted by the Indiana Prevention Resource Center from Imagine Indiana Together – The Framework to Advance the Indiana Substance Abuse Prevention System
CONSIDERATIONS FOR SELECTING AN EVIDENCE-BASE PROGRAM
Time
EBP are often time-intensive
Cost
Program materials for EBP can be costly but creative measures can be taken to reduce costs
Training Requirements
Staff who deliver EBP’s need to be trained in evidence-based procedures
Local Needs
Adapting to local needs of the community requires careful attention to the core components of the program
11 Components of Effective Curricula (Dusenbury & Falco, 1995): 1) Research-based/Theory-driven: Explore the actual causes of drug use and focus on risk AND protective factors. Risk and protective factors include attitudes, behaviors, beliefs, and actions. Specifically, risk factors are conditions that in crease the likelihood of substance abuse and protective factors build resiliency and increase the likelihood that substance abuse will be successfully resisted. 2) Developmentally Appropriate Information about Drugs: Recognize that children and adolescents are more interested in concrete information and here and now experience, than they are on information about possibilities in the distant future. Prevention strategies that combine social and thinking skills are far more effective at changing behavior than programs that simply use lecture-oriented methods to provide information about substances and the adverse effects of substance abuse. 3) Social Resistance Skills Training: Programs most successful at reducing drug-use are schoolbased, social resistance skills training programs that help students identify pressures to use drugs and resist peer pressure while maintaining friendships. 4) Normative Education: Normative education should be supplementary to social resistance training and is critical to long-tem success of drug prevention programs. It stresses the fact that most people do not use drugs. 5) Broader-based Skills Training and Comprehensive Health Education: Objectives include promoting social and academic competence, and preventing a range of risky behaviors like substance abuse, premature sexual involvement, and delinquency. Types of skills covered include decision-making skills, goal-setting, stress management, communication skills, general social skills and assertive skills. 6) Interactive Teaching Techniques: Interactive approaches include modeling, role playing, discussion, group feedback, extended practice, and cooperative learning. Unlike didactic techniques such as lecture, interactive techniques promote active participation. 7) Teacher Training Support: Drug prevention programs are most successful when teachers receive training and support from program developers or prevention experts. Teacher trainers should model interactive training techniques and behaviors during training sessions. 8) Adequate Coverage and Sufficient Follow-up: Prevention effects decay over time. Sufficient and continued follow-up is a critical element of effective prevention programming. 9) Cultural Sensitivity: Drug prevention strategies must be sensitive to the ethnic and cultural backgrounds of the priority population. Deigning culturally relevant and appropriate curricula is difficult however, enabling a well-trained teacher to tailor the curriculum activities to the cultural experience OR having prevention professionals work in close partnership with school personnel may be a viable solution. 10) Additional Components: Family, community, media, and special population components are expected to enhance the effectiveness of drug abuse prevention. 11) Evaluation: The evaluation component of a drug prevention program demonstrates the impact on drug use behavior. At a minimum, evaluation designs should include pretest and post-test and a control group, as well as outcome measures of substance abuse use behavior.
* abstracted by the Indiana Prevention Resource Center from Eleven Components of Effective Drug Abuse Prevention Curricula (Linda Dusenbury & Mathea Falco, Journal of School Health, 65 (10), 1995)