Taking School-Based Substance Abuse Prevention to Scale: District-Wide Implementation of Keep A Clear Mind

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. …