(introduction...)

After reviewing and discussing some of the main issues involved in drug education and prevention, this Chapter will deal with planning educational processes leading to the implementation of drug education programmes. Education can only be successful if it is considered as an activity and a social process, which has to be undertaken in a planned and systematic way. This part of the report highlights some important planning steps to be considered before developing any educational programme (7). Figure 1 shows an overview of the basic planning stages:

FIGURE 1: BASIC PLANNING STAGES IN PREVENTION

PLANNING STEP	BASIC PLANNING QUESTION
Drug problem assessment	What drug problem does the community need to address?
Development of prevention goals	What do prevention workers want to achieve?
Identification of resources and funding sources	What resources does the program need to achieve the objectives? Where will the money come from?
Determination of content and selection of methods and techniques	What does the target group already knows about drugs, how do they behave, communicate about drug users)
Implementation	How will the program be introduced, executed and continued
Evaluation	How can be determined whether the goals are met?

7) Prevention Plus II: Tools for Creating and Sustaining Drug Free Communities. U.S. Department of Health and Human Services, 1989.

Drug abuse assessment

Needs assessment is the part of the planning process that has to reply to the question: "What kind of drug problems does the target group and the educational institution need to address"? The answer is not always obvious, because there may be very different perceptions and definitions of "drug related problems" within a community. However, a complete assessment will try to determine:

- What kind of substances are being used, by whom, in which situations and resulting in what kind of problems (health, social, judicial, criminal etc.)?

- Are selected target groups motivated to change existing consumption practices?

- What skills and strategies are needed to change practices and obstacles that could inhibit the application of such strategies and skills

- What other prevention programmes and aid services already exist to tackle drug problems?

Several needs assessment techniques exist. The preferred methods will depend upon factors, such as time available, funds and other resources. Some examples are:

- case studies;
- social indicators (statistical documentation available in the community);
- service provision surveys;
- key persons studies;
- target population surveys.

Selecting the most appropriate technique requires a balanced consideration of advantages and disadvantages in terms of time, money, staff, reliability of technique, etc.

Developing prevention goals and objectives

After completing the needs assessment, the second step is the determination and formulation of prevention goals or objectives which must be realistic, specific and attainable. For example the goal of a drug free community within the next two years could be considered very unrealistic.

A more attainable goal would be, for example, to reduce drug consumption in a local community by 30% within a two year period. One good way to develop prevention goals is to assign this task to a small group of experts familiar with needs assessment, thus creating a task force comprising key-persons from the community - school counselors, teachers, health educators, local researchers, representatives of the municipality - who would prepare a "white paper" and a plan of preventive action, to be subsequently discussed and accepted by the local community.

A small group would then prepare a plan to educate and train primary health care officers in the early recognition of drug health education and drug use problems and how to deal with young people. Another group could formulate objectives for inclusion in a school curriculum.

Here, it is very important to involve teachers and school counselors in the early planning stages, in order to ensure greater support once the programme begins.

Finally, it is important to monitor and evaluate goals during the implementation of the prevention programme, changing the initial goals if these prove to be unrealistic.

Identification of resources

A whole range of resources, besides money, educational materials etc., are needed to meet the goals of prevention programmes. Expert knowledge of specific issues is required, as is cooperation with media and press officers, support of local community boards and councils and collaboration with rehabilitation and treatment services. It is recommended that a checklist of needs and available resources be drawn up.

An essential part of the planned prevention programme is, of course, the identification and collection of funds and grants. Sometimes the latter are already at the disposal of a prevention organisation, for example, because they have been requested by a local government to initiate a prevention programme. In many cases money is not available or funds are insufficient to start the programme. There are several sources of finance foundation grants, government grants and community fundraising, the latter probably being best known to local prevention organisers. Beside fundraising and requesting grants, beneficiaries of the prevention programme could be asked for a contribution, either to cover all or some of the costs involved, for instance, purchasing educational materials.

Determining the content and selecting methods of the prevention programme

As pointed out earlier, a prevention programme needs well formulated goals. Once these are defined, the content of the programme has to be determined and the methods and techniques which will be used to communicate the content of the programme selected. Before the content of a prevention programme can be determined an analysis has to be made of:

- What the target audience know about drugs and what kind of prejudicial mis-information they have received. On this basis, the programme organizers should indicate what additional, new information the target audience needs.

- The target audience's attitude towards drug use and drug users. Once this is known, it is necessary to determine what should be more appropriate attitudes after the end of the prevention programme.

- The actual behaviour vis-a-vis drug use of the target group; how do they cope with drug users in their own daily situations.

- How do the target groups perceive their contribution to drug abuse prevention. On the basis of this information, a prevention programme might learn of new and better ways of handling preventive activities.

- What the target group knows about existing community prevention efforts might provide suggestions on how to contribute to them.

Answers to these important questions are essential to determine the content of the prevention programme, whether it be an education or information programme, training, or a mass media campaign. Once goals and content are chosen, then the most appropriate communication methods and techniques to implement it can be selected. (See Chapter III).

Implementation

Once the goals, content, methods and activities of the prevention programme have been determined and the support and cooperation of the community has been assured, the programme can begin. In the case of formal education, it is important that a prevention programme should be implemented adequately, because to develop a prevention programme and to integrate it in the general school curriculum requires time and effort on the part of the programme defenders and the school. Again, it should be stressed that all staff and other personnel have to be involved and committed to the prevention programme from the outset. They have to feel that it is their programme and their responsibility to strive for good results.

Implementation will be more successful if the following conditions are met:

- The school has indicated that it will adopt the prevention programme.

- The school has been involved in the initial development stage.

- The conditions (time, costs, content of the programme, educational materials, training facilities etc.) are favourable to the organization or target group.

- The school agrees on the goals, content, methods, location, and time schedule of the programme.

Outside formal education settings, the timing of a fixed-term or continuous prevention programme within the community involving youth clubs, sport or leisure clubs, community citizen centres is very important. For example, inviting citizens to join a drug education programme during holiday periods or high media coverage of sporting events will result in a low attendance. Advertising about the programme in a medium they do not use, or selecting an unfamiliar location, will also result in minimal attendance.

Evaluation

There are several reasons to include an evaluation at the end of a prevention programme First, curiosity of those involved in the programme as to how successful their programme has been. Second, funding resources usually require some form of assessment in order to determine whether their money has been wisely invested. Third, and perhaps most important, an objective evaluation is the only credible method available to determine the effectiveness of preventive activities and programmes.

There are two kinds of evaluation: process evaluation and effect - or outcome evaluation. The central question in process evaluation is: did we accomplish our goals? Why or why not? Has the prevention programme been carried out in the way we intended and planned? Have resources been utilized as initially planned? Have we used the funds appropriately? Was the target group satisfied with the way the prevention programme was carried out? What has been the opinion of the community (local council, key-persons, the media, etc).

The second kind of evaluation deals with the effects of the prevention programme. Whilst, it is not always possible to determine or measure the intended effects or outcomes of prevention efforts, attempts should be made to discover if there is any evidence of reduction of drug use or drug problems in the community, or whether the community is more aware or better informed about drug use and drug problems.

Programmes, target groups and intermediaries

There is no general standard drug education model or drug prevention programme suitable for the whole population or community. Distinctions must be made between different communities and target groups, each population group in a country or local community needing its own prevention programme, often with different goals, content and communication techniques.

There is also a difference in the ways preventive education can reach target groups, not all of whom need to be contacted directly by drug education workers. Some intermediary groups, community key persons or community communication channels (local radio and TV), have regular contacts with specific target groups and can play a crucial role in preventive education 8). Informing, educating and training these intermediaries to carry out educational activities, sometimes referred to as the two-step model of communication 9), can be a very efficient and cost-effective strategy. For example, it is possible to directly provide different risk groups school-leavers, school drop-outs, unemployed youth - with drug information by means of mass media communication. However, this approach is rather time consuming, cost intensive and it would be more appropriate to train key persons who have close relationships and personal contacts, or who are able to communicate in other ways, to inform and persuade groups at risk of the harmful effects of drug abuse. Another approach would be to train and educate primary health care professionals like family doctors, social workers, district nurses who, through daily contacts with families and groups in the local community, can play an important role in drug education and prevention.

8) Buisman, W.R. Drug Prevention in The Netherlands. In: Ghodse, H. A. et.al. Drug Misuse and Dependence, Parthenon. Lancs. 1990

9) Rogers, E.M. Diffusion of Innovations. New York. Free Press. 1983

Figure 2 shows several possibilities of intermediary groups and professions and educational contacts with target groups.

Besides strategical questions of addressing drug education programmes via intermediaries or directly to population target groups, a choice has to be made about the level of prevention at which the intervention will take place: primary (no use of drugs or slight experimentation), secondary (experimentation with drugs, for example, by risk groups) and tertiary prevention (relapse prevention or risky use of new dangerous drugs).

FIGURE 2. INTERMEDIARIES AND TARGET GROUPS

INTERMEDIATE PROFESSION - CONTACT WITH - TARGET GROUPS
· Youth/street workers	Risk groups, school leavers drop outs, unemployed etc.
· Teachers, counselors	Primary school children, secondary school children, adolescents
· Community workers	Citizens, parents, youth groups, out- of-school children
· Local community organisation, sport and cultural	Peer leaders in sport, leisure volunteers
· Primary health care professionals	Patients, partners, parents, families

Figure 3 gives an overview of the three levels of primary, secondary and tertiary prevention 10). Different types of intervention and educational activities that could be applied to a great number of different target groups are indicated. As previously mentioned in this report, prevention programmes can have a unique, one-time character, or can be carried out several times for different target groups in a community. They might also be carried out over a long period, for example, a mass media programme on radio or television running for several months.

10) See Note. 8

On the other hand, especially in the context of formal education a prevention programme might be conducted over a two-year period. An example of a long-lasting drug prevention programme at secondary school level, is the "Skills for Adolescents" programme (11). This educational programme has a broad focus and is very much person and peer group oriented. Beside providing basic facts and information on drugs, it emphasizes values and attitudes, awareness of social influences and the development of personal and social skills like critical thinking, decision-making, etc. The rationale behind the programme is that positive and healthy choices about drug behaviour are much more likely to be made within the context of self-confidence, critical thinking and decision making and an individual's awareness of (negative) social influences he or she is exposed to. However, schools and teachers who decide to carry out this well-tried prevention programme need an average of 8 hours a week at their disposal.

11) Skills for Adolescents. Columbus, Ohio. The Quest National Centre. 1985

FIGURE 3. PREVENTION LEVELS AND TARGET GROUPS

TARGET GROUPS	PREVENTION LEVEL
	PRIMARY	SECONDARY	TERTIARY
Primary school children	X1,2
Secondary school children	X1,2	X3
Adolescents (left school)	X4	X5
Migrant children	X6
Community (children)	X7	X8
Cannabis users		X9
Vulnerable groups	X10	X11
Hard drug users		X 11	X 12
1. Curriculum education. 2. Teacher training. 3. Teacher counselling training. 4. Part-time classes education. 5. Teacher counselling training. 6. Migrant (youth) leader training. 7. Community leader training. 8. Early intervention training. 9. Video and manual training packages. 10. Alternatives to prevention programmes (like Survival tracks) 11. Early intervention programmes. 12. Rehabilitation programmes.

Examples of intensive, comprehensive education and training courses for health professionals can be found in several medical education training programmes in the USA and the Netherlands (12). At the start of medical training, attention is paid to factual knowledge on drugs and drug use and to the development of adequate attitudes. In later years, students are trained in skills of early recognition of drug problems and care and treatment (13).

12) Buisman, W. R. & P. J. Geerlings. The Amsterdam Substance Abuse Programme for Medical Students. Bilthoven, Amsterdam. 1985

13) See Note.

The next Chapter describes methods and techniques of drug education in more detail.