Harmful Legal Product Prevention Project

Harmful Legal Product Prevention Project Peggy Kelley Thu, 10/25/2018 - 02:53 PM EDT

Description

The Harmful Legal Product Prevention Project was part of a National Institute on Drug Abuse pilot project. From 2004 to 2008, researchers, community coalitions, and schools collaborated to implement three primary prevention strategies—the Community Readiness Model, the Home Environmental Strategy, and Think Smart—in rural/frontier Alaskan communities. The strategies were implemented in tandem, though each could be implemented on its own (Gruenewald, Johnson, Shamblen, Ogilvie, & Collins, 2009).

Objective(s)

To assess and improve community readiness to address prescription drug abuse, youth prescription drug, and youth harmful legal product (HLP) abuse; to strengthen parent-child communication, parents’ efficacy to modify home environments in order to limit access to HLPs, and youth skills to resist drug offers; and to decrease youth’s motivation to use drugs and their vulnerability to social influences to use drugs

Typical Elements

  • The Community Readiness Model (CRM) determines community readiness across six dimensions and provides guidance on using survey results to create an action plan to improve community readiness (Colorado State University, 2011). The CRM is based on the Stages of Change Model (Prochaska & Di Clemente, 1982) of how individuals process and experience change, both on their own and in formal settings (Oetting et al., 2014). The steps of CRM implementation are as follows:
    • Step 1: Identify and clearly define the issue
      • Note: In addition to addressing prescription drug abuse, the CRM can be adapted to address underage drinking, binge drinking, illicit drug use, or non-substance-related issues, such as breast cancer prevention (Oetting et al., 2014).
    • Step 2: Identify and clearly define the community you wish to assess and improve (for example, by geographic areas, population subgroups, occupation subgroups, public systems, organizations, or departments within organizations)
    • Step 3: Determine the key dimensions you wish to assess
      • Note: The six dimensions assessed by the CRM are Community Efforts, Community Knowledge of the Efforts, Leadership, Community Climate, Community Knowledge About the Issue, and Resources Related to the Issue (Colorado State University, 2011).
    • Step 4: Prepare survey questions
      • Note: Survey questions should be succinct. They should define the issue of concern and any technical terms used (Oetting et al., 2014). The CRM guidelines contain a standardized format for survey questions (Colorado State University, n.d.).
    • Step 5: Determine how you will score interview responses, in terms of community readiness
      • Note: The CRM identifies nine stages of community readiness:
        • Stage 1: Community tolerance / no knowledge
        • Stage 2: Denial
        • Stage 3: Vague awareness
        • Stage 4: Pre-planning
        • Stage 5: Preparation
        • Stage 6: Initiation
        • Stage 7: Institutionalization/stabilization
        • Stage 8: Confirmation/expansion
        • Stage 9: Professionalization (Colorado State University, 2011)
    • Step 6: Select key respondents for the survey from pools of individuals who are involved in the community and are aware of any efforts to address the selected issue
      • Note: For example, school personnel, law enforcement personnel, court system personnel, city/county/tribal government employees and officials, health system personnel, social service providers, behavioral health treatment providers, spiritual/religious leaders, and community members at large.
    • Step 7: Conduct the interviews
      • Note: The CRM suggests conducting 6 to 12 interviews, although smaller or homogenous communities may only need as few as 4 interviews (Oetting et al., 2014).
    • Step 8: Score interview responses across the key dimensions, using the predetermined scale (Oetting et al., 2014)
    • Step 9: Average scores from each interview to develop overall community scores for each dimension
    • Step 10: Develop and implement an action plan to improve community readiness
    • Step 11: Set goals for improvement based on the dimensional scores
    • Step 12: Create working groups to identify and implement the action plan and activities for improvement
      • Note: In the Alaskan communities, the initial interview responses showed that most students (48% to 91%, depending on the community) thought that it would be “sort of easy” or “very easy” to obtain four types of HLPs. However, the communities received a score of “2” (denial/resistance) or “3” (vague awareness) on their level of knowledge about the issue. The HLP Prevention Project stakeholders identified and developed improvement activities to increase community readiness while also implementing the Home Environmental Strategy and Think Smart (Johnson et al. 2007, p. 9).
  • The Home Environmental Strategy is intended to reduce children’s misuse of HLPs, such as prescription drugs, by removing unnecessary HLPs from the home and locking up and monitoring any HLPs that must remain (Collins, Johnson, & Shamblen, 2012).
    • Note: This model calls for parents to consider substituting HLPs with other products when possible, particularly for HLPs such as markers or glues (Johnson et al., 2007).
    • An important first step in implementing this strategy is to develop and offer Family Night events for parents of school-age children. The goal of Family Night is to increase parental norms related to HLP misuse (such as parental disapproval of children’s HLP misuse, and family rules that reduce the availability of HLPs).
      • These events should last approximately two hours, be held at the school, and occur multiple times over a series of months
      • At the events, provide information to parents on the potential dangers of HLPs and guidance on how to prevent children’s misuse
      • Encourage parents to clearly communicate the dangers of HLP misuse to their children
        • Note: For example, parents might link their HLP message to their own values and beliefs, establish rules and consequences related to HLP misuse, and provide positive reinforcement to children who adhere to family rules regarding HLPs (Johnson, Shamblen, Ogilvie, Collins, & Saylor, 2007).
      • Ask parents to identify and inventory all HLPs in the home
      • Persuade parents to control the availability of HLPs in the home (for example, by locking up and monitoring them)
      • Support other parent-focused prevention efforts, including informal parent-to-parent support
      • Identify parents who may be interested in participating in or supporting community-wide prevention strategies
        • Note: In the Alaskan communities, the Home Environmental Strategy focused on parents of fifth-, sixth-, and seventh-graders. The strategy consisted of a series of Family Night events held over the course of 10 months. Parents were invited to participate through letters and telephone calls, and additional events were held in areas where the first events had low turnout.
  • Think Smart is a weekly interactive school-based program developed for the HLP Prevention Project and derived from the Life Skills Training program for Native American communities; it has been modified to focus on HLPs and for frontier Alaskan communities. However, the strategy is not designed solely for Alaska Natives; it is intended for all frontier Alaskan communities (Johnson et al., 2010). Community coalitions interested in Think Smart may need to modify the program to suit their communities.
    • The Think Smart program (Johnson et al., 2010):
      • Includes 12 weekly core lessons of 45–60 minutes (three booster lessons are implemented two to three months after the core lessons are complete)
      • Is provided by teachers in a classroom setting
      • Draws from behavioral models that “emphasize teaching drug refusal skills, anti-drug norms, personal self-management skills, and general social skills in an effort to resist drug offers, decrease the motivations to use drugs, and decrease vulnerability to drug use social influences” (Johnson et al., 2009, p. 3)
      • Presents stereotypes about drugs (including peer norms and cultural identity), teaches facts about drugs, and then introduce and practice a problem-solving model known as S.O.D.A.S. (Stop, Options, Decide, Act, Self-Talk), which emphasizes refusal and self-assertiveness skills.
    • Before implementing Think Smart, the group or organization should determine the need for additional school-based prescription drug prevention programming and whether the Think Smart program is applicable. Next steps:
      • Obtain program materials, including curricula and “a complete teaching kit with all the items necessary to implement the interactive curriculum (e.g., laminated role play cards, timers)” (Johnson et al., 2010, p. 6)
      • Partner with an intervention agency to provide a two-day onsite training for teachers
      • Offer schools technical assistance throughout the program
      • Schedule weekly sessions for teachers to implement the curriculum
      • Obtain parental consent, if necessary

Populations

Local community members, parents of school-age children, school-age children

Outcomes

  • As part of the HLP Prevention Project, CRM was linked to an average increase in community readiness, as measured by the combined score of all six dimensions (a combined score of 32 pre-action plan implementation, and 34 post-action plan implementation). The largest average increases were in the dimensions of “community knowledge about the issue” and “community resources available to address the issue” (Ogilvie et al., 2008).
  • The Home Environmental Strategy has been linked to parents statistically significantly becoming more likely to lock up prescription drugs (Collins, Johnson, & Shamblen, 2012).
  • The rates of past-30-day HLP use of Alaska students who participated in Think Smart were eight times lower than the rates of students who did not participate, according to a two-group, randomized, matched-control trial (Johnson et al., 2009).

Guidelines

Community Readiness for Community Change.

Acknowledged by

No acknowledgements have been found regarding the role of any HLP prevention project in preventing the nonmedical use of prescription drugs and/or its consequences.

References

Collins, D. A., Johnson, K. W., & Shamblen, S. R. (2012). Examining a home environmental strategy to reduce availability of legal products that can be misused by youth. Substance Use & Misuse, 47(12). doi:10.3109/10826084.2012.716481. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3884673/

Colorado State University. (2011). Community Readiness. Tri-Ethnic Center for Prevention Research. Retrieved from http://www.triethniccenter.colostate.edu/community-readiness-2/

Gruenewald, P. J., Johnson, K., Shamblen, S. R., Ogilvie, K. A., & Collins, D. (2009). Reducing adolescent use of harmful legal products: Intermediate effects of a community prevention intervention. Substance Use & Misuse, 44(14), 2090–2098.

Johnson, K., Courser, M., Holder, H., Miller, B., Ogilvie, K., Moore, R., . . . Saltz, B. (2007). A community prevention intervention to reduce youth from inhaling and ingesting harmful legal products. Journal of Drug Education, 37(3), 227–247. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2443954/

Johnson, K. W., Ogilvie, K. A., Collins, D. A., Shamblen, S. R., Dirks, L. G., Ringwalt, C. L., & Norland, J. J. (2010). Studying implementation quality of a school-based prevention curriculum in frontier Alaska: Application of video-recorded observations and expert panel judgment. Prevention Science, 11(3), 275–286. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3569516/

Johnson, K. W., Shamblen, S. R., Ogilvie, K. A., Collins, D., & Saylor, B. (2009). Preventing youths’ use of inhalants and other harmful legal products in frontier Alaskan communities: A randomized trial. Prevention Science, 10(4), 298–312. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3735174/

Oetting, E. R., Plested, B. A., Edwards, R. W., Thurman, P. J., Kelly, K. J., Beauvais, F., & Stanley, L. (2014). Community readiness for community change. Fort Collins, CO: Tri-Ethnic Center for Prevention Research, University of Colorado. Retrieved from https://www.coursehero.com/file/15527087/Community-Readiness-Handbook-2014/

Ogilvie, K. A., Moore, R. S., Ogilvie, D. C., Johnson, K. W., Collins, D. A., & Shamblen, S. R. (2008). Changing community readiness to prevent the abuse of inhalants and other harmful legal products in Alaska. Journal of Community Health, 33(4), 248–258.

Prochaska, J. O., & Di Clemente, C. (1982). Trans-theoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research, and Practice, 19(3), 276–288. Retrieved from https://www.researchgate.net/publication/232461028_Trans-Theoretical_Therapy_-_Toward_A_More_Integrative_Model_of_Change