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Article Excerpt
Abstract
Public schools are under increased pressure to implement evidence-based substance abuse prevention programs. A number of model programs have been identified, but little research has examined the effectiveness of these programs when "brought to scale" or implemented district-wide. The current paper summarizes the application of the Adelman and Taylor's (1997) model for district-wide program implementation to the dissemination of an evidence-based parent-child drug education program called Keep A Clear Mind (KA CM; Werch & Young, 1990). In addition to documenting the partnership process used to scale-up the program to a district-level, evaluation results are presented from 2,677 fifth graders in 43 schools who participated in the KACM program. Pre-post comparisons from two consecutive cohorts of students indicated a significant reduction in students 'attitudes supporting alcohol use and a significant increase in parent/child communication about prevention, students 'perceived ability to resist peer pressure, and their belief that it is "wrong" to use alcohol, tobacco, and marijuana. Focus groups conducted with a subset of the KACM teachers indicated great support for the KACM program, the partnership approach, and the dissemination model. Findings provide support for Adelman and Taylor's (1997) model as a framework for collaborative district-wide implementation of substance-abuse prevention programs.
The increasing legislative demands on school administrators and district directors to provide safe and orderly school environments have resulted in a greater emphasis on the importance of using evidence-based substance abuse prevention programs. Federal agencies, such as the Substance Abuse and Mental Heath Services Administration (SAMHSA), the U.S. Office of Safe and Drug Free Schools, and the Office of Juvenile Justice and Delinquency Prevention have generated lists of promising, effective, and model substance abuse prevention programs based on careful review of multiple efficacy trials. Although the programs on these evidence-based lists have been shown to have a positive impact when executed in tightly controlled settings, the effectiveness of these programs when implemented by communities and on a large scale is unknown.
The need for more research on the transition from efficacy of school-based substance abuse prevention to effectiveness research (Flay, 1986) is highlighted by the trend in public education toward district-level coordination and implementation of programs. In an effort to cull limited financial resources, school districts often opt to implement one or two evidence-based programs that are widely disseminated by the school district. Coordinated large scale implementation of preventive efforts can potentially improve student outcomes and be more cost-effective for the school system (Greenberg, 2004). Several models for widespread program dissemination and implementation have been proposed (e.g., Adelman & Taylor, 1997; Backer, Lieberman, & Kuehnel, 1986; Fixsen, Naoom, Blase, Friedman, & Wallace, 2005; Cheung & Cheng, 1997; Feldman, Baler, & Penner, 1997; Zins & Illback, 1995); yet, there are few published examples of the application of these models to the successful implementation of substance abuse prevention efforts. The present paper describes the district level implementation of Keep A Clear Mind (KACM; Werch & Young, 1990), an evidence-based substance abuse prevention program, as an illustration of Adelman and Taylor's (1997) multi-phase framework for disseminating school-based programs.
We first describe the Adelman and Taylor dissemination model and show how it was followed by the school district to "roll out" KACM (i.e., systematically phasing the implementation by beginning with a small number of schools and adding more schools over time). Since few published studies have focused on the effects of these types of programs when implemented in a large number of sites, an important aspect of the current study is the presentation of evaluation findings from two consecutive cohorts of fifth graders who participated in KACM. Through this case example, we also highlight the need for more substance abuse prevention effectiveness research and provide recommendations for large scale dissemination efforts.
Multi-Phase Program Diffusion Model
One of the most widely cited models for dissemination of educational reforms was put forth by Adelman and Taylor (1997). Applying research and theories from the fields of community psychology and organizational change, this model outlines an efficient four-stage strategy for implementing programmatic change across large educational settings. We briefly summarize the four stages of this model and then describe how it was used to implement the KACM substance abuse prevention program.
Phase I: Creating Readiness. This first phase of the model stresses the importance of obtaining community and stakeholder "buy-in" (i.e., community support) and preparing the environment for change. One strategy for motivating the community is to provide information about the issue and its local impact (Hogan et al., 2003). This can occur by summarizing research on the potential health risks (e.g., causes and consequences of early substance use), reviewing local data on the severity of the problem (e.g., rates of substance abuse in the community, prevalence of liquor stores in the neighborhood), and listing the current programs or services available to the target population (or lack there of). These and other types of information can be particularly persuasive when there is currently a lack of services, but can also be employed when trying to replace...
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