Topic 4 Collaborating with families and close environment

The socio-ecological model highlights the importance of working across levels to address the constellation of factors that influence both individuals and populations.

Even if schools have a clear policy against alcohol use on school grounds, accepting underage drinking on behalf of the parents and the broader community might have less impact than if the prevention includes changes to the school policy plus education for parents on the dangers of underage drinking or a city ordinance that requires alcohol sellers to participate in training.

The table offers an overview of coordinated prevention strategies.

Level Risk Factor Protective Factor Strategy Example

Individual

  • Genetic predisposition to substance misuse
  • Prenatal exposure to alcohol
  • Poor impulse control
  • Positive self-image
  • Self-regulation and control
  • Social competence
  • One-on-one psychoeducation therapy
  • Social and decision-making skills training

Relationship

  • Parental permissiveness
  • Peer acceptance of heavy drinking
  • Positive parental involvement
  • Peer disapproval of substance use
  • Low peer substance use
  • Parental training on communicating disapproval of use
  • Peer refusal skills training

Community

  • Poor neighbourhood safety
  • Law enforcement permissive of underage substance use
  • Availability of afterschool activities
  • Low perceptions of alcohol use among the general student population
  • Social marketing campaign to promote positive social norms

Societal

  • Law favourable to substance use
  • Historical trauma
  • Limited availability of substances

  • Increase price or tax of alcohol
  • Raise minimum legal drinking age

School-based interventions can have some effect on prevention, in the short term.

As the school has a major role in the lives of youth, schools can be a central coordinating institution for primary prevention and linking them to families, media, and community policies (Stigler, Neusel, & Cheryl, 2011).

Two evidence-based programmes will be presented, as they were described as indicated by the European Monitoring Center for Drugs and Drugs Addiction for talking alcohol with young students (2017).

The first is a Spanish selective multi-component programme, aiming to prevent alcohol use for children that have high-risk behaviour and the second, a German programme of indicated prevention, that aimed at children of substance-abusing parents, who are in turn at substantial risk of developing substance-use and other mental disorders.

There is some evidence that the multicomponent interventions can have some results on intervening alcohol problematic use in young people, especially for delaying alcohol use in the case of children of high risk.

However, there is little evidence that these approaches are more effective than the ones with a single component.

In the case of EmPeCemos, we can say that it is an effective selection strategy as it targets youth with known individual risk factors for alcohol use, including personality risk factors or behavioural problems before the onset of alcohol use.

These programmes show stronger and long-term effects on drinking onset, binge drinking onset, and problem drinking symptoms in high-risk populations.

It is shown that selective prevention strategies on alcohol (for a specific population of the school), can also benefit the universal population.

On contrary, in the case that selective approaches are used with students that are using alcohol and students that have high-risk behaviours, it was shown that youth adopted the unwanted norms than learn about and adopt positive norms.

Children younger than 10 years of age

EmPeCemos (Spain)

Description of methodology:

It is aimed at children (7-10 years old) with early on-set behaviour problems and is conducted in small groups of 5-10 people and 1-2 moderators for each session. It consists of three components to bring changes in the child and its closest environment: 

  1. A family component (12 sessions), which trains parents in appropriate parenting practices and promotes positive relationships in the family and with the school.

The sessions are:

    1. Presentation of the program
    2. Strengthening positive relationships
    3. Involvement in school tasks and family-school cooperation
    4. Improving family communication
    5. Learning to ignore
    6. Management of stress and self-control
    7. Setting limits to behaviour
    8. Setting expectations
    9. Consequences for misbehaviour
    10. Consequences on misconduct
    11. Teaching children to solve problems
    12. End of program.
  1. A component aimed at children (12 sessions), to develop emotional skills (identification and regulation emotions), cognitive (perspective-taking and problem-solving) and social (non-verbal communication and establishing friendships).

The structure includes two (2) general sessions:

    1. Presentation and establishment of group dynamics, and
    2. Child self-control techniques

In addition, it included three (3) specific block themes, divided into sessions

a)Emotional block:

    1. Learning to know emotions
    2. Learning to know the emotional skills
    3. Responding to negative emotions 

b)Cognitive block:

    1. Taking perspectives and solving problems
    2. Troubleshooting

c)Social skills block:

    1. Us and others
    2. Developing skills to make friends, and
    3. General review
  1. A component aimed at teachers (8 sessions), to equip them with the promotion of positive behaviours in the classroom, management of disruptive behaviours, and collaboration with the family.

The sessions were:

    1. Presentation of the programme
    2. The power of praise
    3. Collaboration with the family
    4. Establishing class rules
    5. Effective instructions
    6. Setting Expectations
    7. The use of negative consequences

There is a close collaboration among all components:

  1. Parents and teachers collaborate with the children for designing work plans.
  2. Parents and teachers support the children’s skills development as they are also trained on those skills that children are learning, and in this way, the school and house environment are aligned.
  3. Children practice their skills through activities that include the involvement of their parents and teachers.

Regarding the methodology of the sessions, diverse dynamics are included, based on the principles of social learning and cognitive-behavioural principles: instructions by monitors, discussion, observation, modelling, guided behavioural trials, feedback and practice in natural contexts.

This kind of practice is seen as a central ingredient within the program as it is based on everyday contexts, planned, supervised from the program, and applied in the specific problems of each participant.

In this way, the students have the chance to express their troubles and find solutions in a protected environment.

Children 8-12 years old

Trampoline (Germany)

Description of methodology:

This prevention program is selective and targets children aged 8-12 from families with at least one substance-use parent and aims to prevent substance use disorders.

The main goals are:

  • Teach strategies to handle stress situations provoked by the substance abuse or dependency of the parents.
  • Increase the knowledge of the children about alcohol and drugs.
  • Decrease the effects of the substances on people and of disorders provoked by substance use.
  • Improve how one sees him/herself as a person.

This prevention programme contains elements of psychoeducation, emotion regulation skills, strengthening of self-efficacy and self-worth, stress management and problem-solving strategies. The material includes 9 modules:

  • Module 1 – getting to know each other
  • Module 2 – self-worth: how I feel about myself
  • Module 3 – alcohol and/or drug problems in my family
  • Module 4 – knowledge: what I need to know about drugs and addiction
  • Module 5 – handling difficult emotions
  • Module 6 – self-efficacy: what I can do to solve problems
  • Module 7 – learning new patterns of behaviour in my family
  • Module 8 – what I can do to find help and support
  • Module 9 – a positive good-bye

The manual includes nine weekly 90-minute modules for children, as well as two optional sessions for their parents.  Each module follows the same structure for the children:

  • how children feel that day
  • discussion of the “homework” from the previous session
  • introduction of the new topic
  • develoment of the material of the new topic

It is considered that this structure is especially useful for these children for whom appropriate attention is often lacking from home. The methodology includes a lot of practice and role-playing.

Regarding the modules of the parents, there is one at the beginning of the intervention and one at the end.

The first one aims at informing parents about the intervention and the risk and protective factors for their children when they grow in a substance environment.

The parents share their hopes and are encouraged to use their parenting skills with their kids.

At the end of the intervention, this module includes some results regarding the programme, and the parents ask questions they might have occurred during the prevention period at home or ask for support if they consider they need it.

For these two modules, there is a manual for parents to follow.

In case of interest, check also the “Project Northland”, which was considered as a highly effective programme, and included school-based education programs, community activities and outreach, and environmental strategies that reduced the availability of alcohol to youth. 

Activity:

Based on the methodologies described in the case studies, you can adapt your lesson plan, in terms of methodology or materials used to make it more appropriate for working with the prevention of alcohol use with your students.