1 Promoting Positive Youth Development, Health, and Well-Being through Life Skills Training Christopher Williams, Ph.D.Pamela Werb, MEdNational Health Promotion AssociatesThis product is supported by Florida Department of Children and Families Substance Abuse and Mental Health Program Office funding.
2 Overview Background Theory and Description Effectiveness Potential for Educational OutcomesBotvin LifeSkills TrainingImplementation ConsiderationsQ & A
5 Priority Health-Risk Behaviors Monitored by CDC (YRBSS) Behaviors that contribute to the leading causes of mortality and morbidityTobacco useAlcohol and other drug useMotor vehicle accidentsOther unintentional injuriesViolence (Suicide, Homicide)Sexual behaviorsUnhealthy dietary behaviorsInadequate physical activityThe YRBSS monitors priority health-risk behaviors that contribute to the leading causes of morbidity and mortality among youth and adults: unintentional injuries and violence, tobacco use, alcohol and other drug use, sexual behaviors, unhealthy dietary behaviors and, inadequate physical activity. The YRBSS also monitors two health outcomes: obesity and asthma.5
6 Prevention Science Advances in Etiology and Prevention Multiple health behaviorsToward a unified fieldConvergenceSimilar etiologic factors and courseShared methods and theoriesSimilar effective approaches
7 Institute Of Medicine Classification: Continuum of Care Use of the term “prevention” is reserved for interventions occurring prior to the onset of a disorder. UNIVERSAL prevention focus on the general population. SELECTIVE prevention targets specific high risk groups or subsets of the general population. INDICATED prevention is for individuals showing early warning signs of a disorder.
8 Early Prevention Efforts: Ineffective Health InformationScare TacticsSchool Assembly ProgramsIneffectiveDrug information programs increased use in some studiesIneffectiveness of information-based approaches: Elmquist, 1995; Hanson, 1992; Moskowitz, Results of some studies (e.g., Tobler, 1986) indicated that providing drug information can actually increase drug use.
9 Evidence-Based Approaches Tested and Proven EffectiveWell-Designed (Randomized Control Trials)Carefully ExecutedRigorous Research MethodsAppropriate Data AnalysisPublished in Peer-Reviewed JournalOne or More Replications
10 Substance Use Behavior Etiology Studies Show Hypothesized Mediating Variables Associated with Adolescent Substance UseAssertivenessRefusal skillsDecision-makingProblem-solving skills_Substance Use BehaviorPeer substance usePerceived normsSocial anxietyRisk-takingPositive drug expectancies+
11 Intervention Effects Observed on Key Hypothesized Mediating Variables AssertivenessRefusal skillsDecision-makingProblem-solving skillsLocus of control+Life Skills Training_Peer substance usePerceived normsSocial anxietyRisk-takingPositive drug expectancies
12 Life Skills Training: Conceptual Model and Brief Description
13 Model of Adolescent Drug Use and Focus of LST Program Socio-CulturalPersonalCompetenceSkillsRisk andProtectiveFactorsFamilySocialCompetenceSkillsDrug UseSocialEnvironmentDrugResistanceSkills/CognitionsLifeSkillsTrainingContextualFactorsIndividualFactors
14 Life Skills Training Major Components Personal CompetenceSocial CompetenceResistance Skills, Attitudes and Norms
15 Personal Competence Skills Problem-Solving and Decision-MakingPersonal Behavior Change SkillsStress and Anxiety Management
16 Social Competence Skills Communication SkillsGreetings and Brief Social ExchangesMeeting New PeopleConversational SkillsComplimenting SkillsAssertive Skills
17 Resistance Skills/Norms Awareness of Drug Use InfluencesAnti-Drug Use NormsResistance SkillsLST teaches the skills, attitudes, and norms necessary to resist pressures to engage in unhealthy behaviors such as tobacco, alcohol, or illicit drug use.
19 Evidence of Effectiveness Over 30 Peer-Reviewed StudiesShort, Intermediate, and Long-termMajority and Minority YouthTobaccoAlcohol and Illicit Drug UseOther Health OutcomesIndependent ReplicationCost Benefit of LST: Steve Aos, Washington State; Mark Greenberg, Penn State; Dick Spoth, U of Iowa19
21 Methodological Issues RCT: Cluster RandomizationValidity of Self ReportIDs for Tracking Individual StudentsPretest EquivalenceDifferential Attrition/Data LossAppropriate Analysis (ICCs, Covariates)GEE, Mixed Model GLM, GLM with School as Unit of Analysis
25 Life Skills Training Short-Term Effects LST Control 30 25 20 Percent Using Monthly15105Tobacco*Alcohol**Marijuana***Source: *Botvin et al. (1982), ** Botvin, Baker et al. (1984), *** Botvin, Baker, Renick et al.(1984).
26 Source: *Botvin et al. (1983), ** Botvin et al. (1990) Life Skills TrainingBooster EffectsSource: *Botvin et al. (1983), ** Botvin et al. (1990)5101520Percent Using WeeklyTobacco*Marijuana**LST + BoosterLSTControl
28 Life Skills Training Long-Term Effects: Smoking LST Control 30 25 20 28% ReductionLSTControl302529% Reduction2020% ReductionPercent Using21% Reduction15105Weekly Smoking*Weekly Smoking**Daily Smoking*Daily Smoking**(White Sample)(Minority Sample)(White Sample)(Minority Sample)Source: *Botvin et al. (1995), ** Botvin et al. (2004)
29 Life Skills TrainingLong-Term Effects: Gateway Poly-drug Use & Illicit Drug Use25% ReductionLSTControl3038% Reduction2520Percent Using1556% Reduction50% Reduction105Polydrug Use*Narcotics**Hallucinogens**Illicit Drug Use**(Weekly)(Lifetime)(Lifetime)(Lifetime)Source: *Botvin et al. (1995), ** Botvin et al. (2000)
30 Life Skills Training Binge Drinking (Botvin et al., 2001) Binge drinking – 5+ drinks in a row.Reduced binge drinking by 50% or more.
37 Potential Educational Outcomes Attendance, Engagement, and CommitmentSafe, Supportive Learning EnvironmentAbility to Handle Academic PressuresPro-social Engagement with Teachers and PeersPromotion of Social and Emotional LearningBetter Choices In and Out of ClassroomBy preventing problem behaviors and providing students with the skills needed to remain resilient and succeed in the face of new challenges, LST can contribute to a sense of mastery that enhances school bonding, engagement, commitment, and attendance.When students feel safe, they can learn better and thrive. LST can help create and reinforce a safe and accepting school environment.LST can help students handle school pressure by promoting greater self-esteem and self-confidence through goal-setting and self-monitoring, and by helping students learn the skills to effectively cope with stress and anxiety.Students do not learn alone but rather in collaboration with their teachers and other students. Youth with good social skills are better prepared for learning, are able to ask their teachers for assistance with academic and personal problems, and can elicit and provide social support from peers. By promoting social skills, LST can enhance a student’s ability to interact with others in the process of learning, increasing academic competence over time.Schools play an important role not only in teaching cognitive academic skills but also in fostering social and emotional development. However, schools have limited resources and are increasingly concerned with academic outcomes. LST can enhance social and emotional skills, in addition to preventing several problem behaviors. Thus, LST is an efficient way to teach students a variety of important skills, promote positive youth development, and decrease multiple problem behaviors.LST teaches students the necessary skills to resist peer and media pressure to engage in unhealthy behaviors. Through in-class activities and behavioral homework assignments, LST can give students the skills to make better decisions and solve problems. Youth who learn these skills are likely to make more appropriate choices in and out of school which, in turn, supports academic success.
42 Program Providers Health Educators Prevention Specialists Peer Leaders Teachers
43 Teaching Methods Facilitate Discussion Teach Skills Provide ReinforcementProvide Opportunities for Skills Practice
44 What is the age range for LST? AgesThe Botvin LifeSkills Training evidence-based approach spans multiple age groups. Materials are adapted for age and developmental appropriateness.
45 Sessions per Level Level Grade Level # of sessions Duration Elementary 3rd8 sessions45 – 50 minsLevel 24thLevel 35thMiddle School Level 16th15 core + 3 optionalMiddle School Level 27th10 core + 2 optionalMiddle School Level 38th5 core + 4 optionalHigh School9th or 10th10 sessionsTransitions11th or 12th6 sessions
46 Elementary Program Content by Grade/Level TopicL1: 3rd/4thL2: 4th/5thL3: 5th/6thSelf-Esteem1Decision-MakingSmoking InformationAdvertisingDealing with StressCommunication SkillsSocial SkillsAssertivenessTotal Class Periods8
47 Middle School Program Structure & Content By Grade/Level Middle School UNITSL1: 6th/7thL2: 7th/8thL3: 8th/9thSelf-Image & Self-Improvement1Decision-Making2Substance Use / Drug Abuse4Advertising/ Media InfluencesViolence and the MediaCoping with AnxietyCoping with AngerCommunication SkillsSocial SkillsConflict ResolutionAssertivenessResisting Peer PressureTotal Class Periods15/1810/125/9
48 High School Program Content UnitSkills# of Lessons1. Understanding PreventionPersonal Self Management12. Decision Making for Health3. Drug Use and Risk TakingDrug Resistance4. Health in Media and Culture25. Managing Stress and Anger6. Family CommunicationsGeneral Social7. Building Healthy RelationshipsTotal Class Periods7 Units / 10 Lessons
49 Transitions Program Content UNITCOMPETENCY DOMAIN1. Goal Setting for SuccessPersonal Self Management Skill2. Effective CommunicationGeneral Social / Social Environment Skill3. Managing Stress4. Decision Making and RiskPersonal Self Management / Social Environment Skill5. Managing Time and Money6. Building RelationshipsPersonal / General Social / Social Environment SkillsTRAINER NOTESINSTRUCTIONSReview the scope and sequence of the program.Define fidelity as delivering the full scope and sequence of the program as it has been designed.Ask for and respond to questions about scope, sequence, implementation and fidelity.POINTS TO MAKEBest outcomes of the program are achieved when it is delivered with fidelity to program scope and sequence, teaching methods and content.PROGRAM FIDELITY:Teach the lessons in order at least one time per week in consecutive weeks, allow 45 – 50 minutes per lesson and deliver all of the activities in the lesson.4949
50 Skills TrainingInstruction Demonstration Behavior Rehearsal Feedback Reinforcement Extended Practice
52 What are the fidelity guidelines? Best results are achieved with provider fidelityTeach the full scope and sequenceTeach the units in orderTeach at least 1 X week. Can be taught more than one time per week if needed.Use interactive teaching techniquesTeach the booster sessionsOptimum fidelity is achieved through planning with participation of stakeholders
53 Is implementation fidelity important? YES!There are different ways to monitor fidelity using checklists.Peer observation and feedbackSelf-monitoring and assessmentThe LST fidelity checklists help providers:Review key lesson points and instructional objectives during preparationIdentify areas that can be challengingFocus on important lesson goals and objectivesReceive specific feedback on their ability to adhere to the lesson plan
54 Is there digital support for instruction? Yes. There are digital support slides to help enrich learning and focus participants attention on key concepts, vocabulary, and lesson points.The LST Digital Support Slides help providers:Utilize available technology in the classroomHighlight critical vocabulary and concepts prior to skills practiceSummarize essential information from each lessonIn addition, many of the program levels have optional CD ROMs or companion websites. These can aide to increase practice outside of the lesson and reinforce concepts when not in class.
55 LST Session Support Slides Each level and each unit Designed to bring attention to:Lesson goals and objectivesKey vocabulary and definitionsImportant summary pointsAvailable for Middle SchoolHS and Transitions (2014)
56 LST: Summary Over 30 Peer-Reviewed Studies White, African-American, and Latino YouthSizeable and Sustained EffectsATOD, Meth, Violence, Risky DrivingReplication by Other Researchers$25 Benefit for Each $1 SpentPotential Educational Outcomes
57 Recognition of Excellence Recognized for excellence and quality by:U.S. Department of EducationU.S. Justice Department, Office of Juvenile Justice Delinquency and Prevention (OJJDP)Blueprints Model ProgramNational Institute on Drug AbuseWhite House Office on National Drug Control PolicyDOJ Office of Justice Programs
58 Conclusions LST = strong and lasting effects Widely Used All 50 States in US32 Countries WorldwideApproaches targeting school, family, and community offer greatest potentialPromote sustained use of proven approachesDevelop prevention infrastructure