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Christopher Williams, Ph.D. Pamela Werb, MEd

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1 Promoting Positive Youth Development, Health, and Well-Being through Life Skills Training
Christopher Williams, Ph.D. Pamela Werb, MEd National Health Promotion Associates This 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 Outcomes Botvin LifeSkills Training Implementation Considerations Q & A

3 Background


5 Priority Health-Risk Behaviors Monitored by CDC (YRBSS)
Behaviors that contribute to the leading causes of mortality and morbidity Tobacco use Alcohol and other drug use Motor vehicle accidents Other unintentional injuries Violence (Suicide, Homicide) Sexual behaviors Unhealthy dietary behaviors Inadequate physical activity The 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 behaviors Toward a unified field Convergence Similar etiologic factors and course Shared methods and theories Similar 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 Information Scare Tactics School Assembly Programs Ineffective Drug information programs increased use in some studies Ineffectiveness 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 Effective Well-Designed (Randomized Control Trials) Carefully Executed Rigorous Research Methods Appropriate Data Analysis Published in Peer-Reviewed Journal One or More Replications

10 Substance Use Behavior
Etiology Studies Show Hypothesized Mediating Variables Associated with Adolescent Substance Use Assertiveness Refusal skills Decision-making Problem-solving skills _ Substance Use Behavior Peer substance use Perceived norms Social anxiety Risk-taking Positive drug expectancies +

11 Intervention Effects Observed on Key Hypothesized Mediating Variables
Assertiveness Refusal skills Decision-making Problem-solving skills Locus of control + Life Skills Training _ Peer substance use Perceived norms Social anxiety Risk-taking Positive drug expectancies

12 Life Skills Training: Conceptual Model and Brief Description

13 Model of Adolescent Drug Use and Focus of LST Program
Socio- Cultural Personal Competence Skills Risk and Protective Factors Family Social Competence Skills Drug Use Social Environment Drug Resistance Skills/ Cognitions Life Skills Training Contextual Factors Individual Factors

14 Life Skills Training Major Components
Personal Competence Social Competence Resistance Skills, Attitudes and Norms

15 Personal Competence Skills
Problem-Solving and Decision-Making Personal Behavior Change Skills Stress and Anxiety Management

16 Social Competence Skills
Communication Skills Greetings and Brief Social Exchanges Meeting New People Conversational Skills Complimenting Skills Assertive Skills

17 Resistance Skills/Norms
Awareness of Drug Use Influences Anti-Drug Use Norms Resistance Skills LST teaches the skills, attitudes, and norms necessary to resist pressures to engage in unhealthy behaviors such as tobacco, alcohol, or illicit drug use.

18 Effectiveness

19 Evidence of Effectiveness
Over 30 Peer-Reviewed Studies Short, Intermediate, and Long-term Majority and Minority Youth Tobacco Alcohol and Illicit Drug Use Other Health Outcomes Independent Replication Cost Benefit of LST: Steve Aos, Washington State; Mark Greenberg, Penn State; Dick Spoth, U of Iowa 19


21 Methodological Issues
RCT: Cluster Randomization Validity of Self Report IDs for Tracking Individual Students Pretest Equivalence Differential Attrition/Data Loss Appropriate Analysis (ICCs, Covariates) GEE, Mixed Model GLM, GLM with School as Unit of Analysis



24 Short-Term Effects

25 Life Skills Training Short-Term Effects LST Control 30 25 20
Percent Using Monthly 15 10 5 Tobacco* 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 Training Booster Effects Source: *Botvin et al. (1983), ** Botvin et al. (1990) 5 10 15 20 Percent Using Weekly Tobacco* Marijuana** LST + Booster LST Control

27 Long-Term Effects: 5 Years (Grade 12)

28 Life Skills Training Long-Term Effects: Smoking LST Control 30 25 20
28% Reduction LST Control 30 25 29% Reduction 20 20% Reduction Percent Using 21% Reduction 15 10 5 Weekly 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 Training Long-Term Effects: Gateway Poly-drug Use & Illicit Drug Use 25% Reduction LST Control 30 38% Reduction 25 20 Percent Using 15 56% Reduction 50% Reduction 10 5 Polydrug 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.

31 Long-Term Effects: 5 Years (Grade 12)

32 Violence and Delinquency
Source: Botvin et al., Preventing youth violence and delinquency through a universal school-based prevention approach. Prevention Science, 2006

33 Long-Term Follow-Up: 12 Years (Young Adult) Illicit Drug Use

34 Research Design Grade 7th 8th 9th 10th 12th Young Adult Follow-Up LST
O X O X O O Controls O O Note: X = preventive intervention (LST) O = observation point (self-report survey) Mean age of sample = 24

35 Long-Term Follow-Up by Condition

36 Long-Term Follow-Up by Condition

37 Potential Educational Outcomes
Attendance, Engagement, and Commitment Safe, Supportive Learning Environment Ability to Handle Academic Pressures Pro-social Engagement with Teachers and Peers Promotion of Social and Emotional Learning Better Choices In and Out of Classroom By 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.

38 Q & A

39 Break

40 What is Botvin LifeSkills Training?

41 Self-Management Skills
Personal Self-Management Skills General Social Skills Resistance Skills

42 Program Providers Health Educators Prevention Specialists Peer Leaders

43 Teaching Methods Facilitate Discussion Teach Skills
Provide Reinforcement Provide Opportunities for Skills Practice

44 What is the age range for LST?
Ages The 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
3rd 8 sessions 45 – 50 mins Level 2 4th Level 3 5th Middle School Level 1 6th 15 core + 3 optional Middle School Level 2 7th 10 core + 2 optional Middle School Level 3 8th 5 core + 4 optional High School 9th or 10th 10 sessions Transitions 11th or 12th 6 sessions

46 Elementary Program Content by Grade/Level
Topic L1: 3rd/4th L2: 4th/5th L3: 5th/6th Self-Esteem 1 Decision-Making Smoking Information Advertising Dealing with Stress Communication Skills Social Skills Assertiveness Total Class Periods 8

47 Middle School Program Structure & Content By Grade/Level
Middle School UNITS L1: 6th/7th L2: 7th/8th L3: 8th/9th Self-Image & Self-Improvement 1 Decision-Making 2 Substance Use / Drug Abuse 4 Advertising/ Media Influences Violence and the Media Coping with Anxiety Coping with Anger Communication Skills Social Skills Conflict Resolution Assertiveness Resisting Peer Pressure Total Class Periods 15/18 10/12 5/9

48 High School Program Content
Unit Skills # of Lessons 1. Understanding Prevention Personal Self Management 1 2. Decision Making for Health 3. Drug Use and Risk Taking Drug Resistance 4. Health in Media and Culture 2 5. Managing Stress and Anger 6. Family Communications General Social 7. Building Healthy Relationships Total Class Periods 7 Units / 10 Lessons

49 Transitions Program Content
UNIT COMPETENCY DOMAIN 1. Goal Setting for Success Personal Self Management Skill 2. Effective Communication General Social / Social Environment Skill 3. Managing Stress 4. Decision Making and Risk Personal Self Management / Social Environment Skill 5. Managing Time and Money 6. Building Relationships Personal / General Social / Social Environment Skills TRAINER NOTES INSTRUCTIONS Review 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 MAKE Best 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. 49 49

50 Skills Training Instruction Demonstration Behavior Rehearsal Feedback Reinforcement Extended Practice

51 Teaching Skills

52 What are the fidelity guidelines?
Best results are achieved with provider fidelity Teach the full scope and sequence Teach the units in order Teach at least 1 X week. Can be taught more than one time per week if needed. Use interactive teaching techniques Teach the booster sessions Optimum 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 feedback Self-monitoring and assessment The LST fidelity checklists help providers: Review key lesson points and instructional objectives during preparation Identify areas that can be challenging Focus on important lesson goals and objectives Receive 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 classroom Highlight critical vocabulary and concepts prior to skills practice Summarize essential information from each lesson In 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 objectives Key vocabulary and definitions Important summary points Available for Middle School HS and Transitions (2014)

56 LST: Summary Over 30 Peer-Reviewed Studies
White, African-American, and Latino Youth Sizeable and Sustained Effects ATOD, Meth, Violence, Risky Driving Replication by Other Researchers $25 Benefit for Each $1 Spent Potential Educational Outcomes

57 Recognition of Excellence
Recognized for excellence and quality by: U.S. Department of Education U.S. Justice Department, Office of Juvenile Justice Delinquency and Prevention (OJJDP) Blueprints Model Program National Institute on Drug Abuse White House Office on National Drug Control Policy DOJ Office of Justice Programs

58 Conclusions LST = strong and lasting effects Widely Used
All 50 States in US 32 Countries Worldwide Approaches targeting school, family, and community offer greatest potential Promote sustained use of proven approaches Develop prevention infrastructure

59 Q & A

60 Contact us: National Health Promotion Associates
Botvin LifeSkills Training TEL: (914) IN FLORIDA Mr. Andrew Martin (FL Regional Coordinator) TEL: (786)

61 Thank You!

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