1. Experiences of implementation of EU Prevention Quality Standards
Harry Sumnall

2. Acknowledgements
Angelina Brotherhood, LJMU & University of Vienna; EDPQS Prevention Standards Partnership
With financial support from the Drug Prevention and Information Programme of the European Union

3. Slide courtesy of Marica Ferri
Prevention
Prevention (environmental, universal, selective and indicative) interventions are targeted at the general population, at populations at risk of developing a substance use problem or at populations/individuals with an identified problem. They can be aimed at preventing, delaying or reducing drug use, its escalation and/or its negative consequences in the general population and/or subpopulations; and are based on an assessment of and tailored to the needs of the target population;
Those developing prevention interventions have competencies and expertise on prevention principles, theories and practice, and are trained and/or specialised professionals who have the support of public institutions (education, health and social services) or work for accredited or recognised institutions or NGOs;
Those implementing prevention interventions have access to and rely on available evidence-based programmes and/or quality criteria available at local, national and international levels;
Prevention interventions form part of a coherent long-term prevention plan, are appropriately monitored on an ongoing basis allowing for necessary adjustments, are
evaluated and the results disseminated so as to learn from new experiences.
Slide courtesy of Marica Ferri

4. Quality Standards +
Support organisations to work to the same outcomes
Reduce unnecessary variability in delivery
Useful evaluative tool
Helps organisations demonstrate commitment to ‘quality’
Supports decision makers in funding -
Acceptability of developers
Standardise language but don’t standardise practice
Do not necessarily lead to improvements in outcome
Resistance to change
Without incentive, organisations work to achieve the minimum and no more
Principles and rules set by recognised national or international bodies about what to do and what to aim for.
Standards propose clear and aspirational, yet measurable, statements related to content issues, to processes, or to structural (formal) aspects of quality assurance, such as environment and staffing composition
EMCDDA,

5. We need to better understand prevention system structures
Babor et al., 2008
We need to better understand prevention system structures

6. What are the EDPQS?
The European Drug Prevention Quality Standards (EDPQS) have been developed since 2008.
They:
Provide a comprehensive set of criteria to help users learn how to recognise ‘high quality’ prevention activities
Outline the necessary structural and procedural aspects of high quality prevention, i.e. the context in which quality interventions and policies can take place
Support strategies to develop, implement, and review effective evidence based prevention
EDPQS do not prescribe what interventions to undertake, but they focus on how prevention is undertaken.
Importance of context = high quality interventions cannot take place if the supporting structures are not also of a high quality (e.g. poorly trained staff members cannot deliver high quality prevention)
A focus on structural aspects means that quality standards can be relevant in different contexts and in relation to different types of interventions.
The EDPQS do not imply that everybody has to undertake the same intervention, but they seek to ensure that the level of quality is similar - even if the interventions themselves aren’t the same.
EDPQS are not prevention guidelines. The EDPQS do not prescribe any particular type of intervention or policy (e.g. they don't state “deliver intervention X for 3 weeks”); or provide step-by-step instructions on how to undertake high quality preventive work (e.g. they don't explain how to undertake a needs assessment or how to evaluate projects).
However, the EDPQS point users in the right direction of where to find this type of guidance

7. EDPQS present a drug prevention project cycle as their core structure
1 Needs Assessment
8 Dissemination and Improvement
2 Resource Assessment
CROSS-CUTTING CONSIDERATIONS
A: Sustainability and funding
B: Communication and stakeholder involvement
7 Final Evaluations
3 Programme Formulation
C: Staff development
D: Ethical drug prevention
In organising the standards, it was found that the project cycle offered the most intuitive way of structuring the standards.
At this level, the standards are organised according to different project stages representing an idealised life cycle of a prevention project, moving from needs and resource assessment, through to the formulation of the programme and planning its implementation, to the actual implementation, evaluation and a stage of improvement.
The project cycle is useful because it helps to think about prevention activities in a structured way and as a sequence of activities.
Importantly, delivery of the intervention (i.e. implementation) takes place only in the 6th project stage. Consequently, the EDPQS help to make explicit all the planning and preparatory work that goes into an intervention before it is delivered.
At the centre of the project cycle, there are some cross-cutting considerations – these are relevant at every stage of a project and therefore they were placed into the middle rather than allocated to any particular project stage.
Since the EDPQS provide standards on all these stages and topics, they offer one comprehensive resource outlining all the formal aspects of drug prevention activities.
Note - The project stages are numbered to make the practical work with the standards easier, but they are not intended to dictate a strict order or to represent priorities. It is important to remember that the project cycle is a model used to organise the standards – in reality, projects may go through the project stages in a different way.
6 Delivery and Monitoring
4 Intervention Design
5 Management and Mobilisation of Resources

8. What does ‘high quality’ prevention look like
In EDPQS
Differences In wider practice?
Relevant to target populations;
Make reference to relevant policy;
In line with principles of ethical conduct;
Make use of the best available scientific evidence;
Generate evidence;
Achieve specified objectives;  
Practically feasible;
Sustained for as long as the target population requires it  
Relevant to acutely presented needs
Help to achieve secondary outcomes
Make reference to funding & commissioning priorities
Responsive to public and political priorities
Achieve monitoring objectives
Utilise and value a range of (difference) evidence sources
Sustained for as long as funding allows
Still lots of overlap, but differences may emerge

9. EDPQS Theory of change Input
Time, money, expertise regarding quality and quality standards, support from partner organisations and potential users of standards, supportive structures (prevention systems, professional cultures, political context)
 
Activities
Development, translation and effective dissemination of quality standards, activities to support quality in prevention at the systems level
Output
Quality standards and materials/workshops to support their uptake and use in practice
Reach
Those involved in funding, managing, developing, implementing, evaluating or otherwise supporting drug preventive work
Outcomes
Increased awareness, motivation and skills relating to quality and quality standards, as well as use of standards to develop and improve prevention activities
Impact
Increased quality of preventive work, changes in professional prevention culture (i.e. poor quality no longer acceptable), better outcomes for target populations

10. How do we expect QS to make a difference ?
Inputs
Activities
Outputs
Reach
Outcomes
Impact
Existing quality standards
Development of EDPQS and support materials
Introductory materials
Decision makers
Awareness of ‘quality’ as an issue
Increased quality of preventive work
EMCDDA Manual & Quick Guide
‘EDPQS champions’
Practitioners
Motivation to achieve quality standards
Changes in professional prevention culture
Translation/ adaptation and publication of quality standards
Funding
Programme developers
Skills (e.g. knowing how to apply EDPQS)
Potential target audiences
EDPQS Toolkits
Researchers
Evaluators
Dissemination of EDPQS
Better outcomes for target populations
New sets of standards based on EDPQS
This slide shows a simplified version of the EDPQS Theory of Change. The Theory illustrates the mechanisms through which the introduction of quality standards is supposed to lead to better outcomes for target populations, thus also emphasising under what conditions the EDPQS can achieve their aim.
Under “Outcomes”, it is hoped that dissemination of the EDPQS will help people to become aware of the need for quality in prevention, to become motivated to use quality standards, and develop the skills required to apply quality standards. This should then lead to people adopting quality standards in their work (e.g. using them to review prevention activities) and taking the necessary steps to improve prevention practice. This would lead to the desired “Impact”: increased quality of preventive work, changes in the professional culture, and better outcomes for target populations.
The slide reminds us that the ultimate aim of any prevention-related activity, including the introduction of quality standards, is to achieve better outcomes for target populations.
Supportive partners
Adoption (using EDPQS)
EDPQS champions
Trainers
Implementation activities
Outputs of dissemination activity (e.g. workshops)
Supportive structures
Implementation (changing how things are done)
General public
Ultimate target populations

11. How can standards be used?
There are many uses, including:
Planning new projects
Identifying strengths and weaknesses of prevention initiatives
Reviewing the quality of ongoing or completed prevention initiatives
Assessing whether a prevention related activity is undertaken or likely to operate in a way that can be considered “high quality”
Developing and improving the quality of existing prevention provision
Professional and organisational development – self-reflection, training and education
Evidence-based policy-making – helping to achieve the aims of broader national and international strategies and policies
Developing or updating existing quality criteria or standards
These are the uses that we think the EDPQS are useful for; there may be others

12. Quality Standards are used in diverse ways
Development of new prevention actions
Consensus- and awareness-building activities
Training, advocacy, knowledge exchange
Local adaptation and use
More information on these examples can be found on the Prevention Standards website:

13. Lots of relevant lessons from implementation science…
Provides clear and succinct messages, with simple, focussed objectives that require small practical changes;
Refers to reliable and credible sources, with accurate, evidence-based information;
Utilises an interactive format that is appealing, persuasive and encourages participation;
Tailors information so that it is personalised and can modified to the local setting without disrupting the overall aims of the QS;
Highlights the relevance of information (i.e. QS) to the user and their client needs;
Includes clear identification of roles and activities
Supports systems or procedures that are accessible and easy to use, with little effort required to comply;
Includes assessment of, and focus on barriers to change;
Addresses changes at multiple levels, including the individual practitioner behaviour, organisational structure and culture, and health system policy;
Identifies organisational changes that require practitioners to respond or take action (e.g., automatic prompts and obligatory responses);
Reinforces key messages with additional materials and support;
Provides for the sustainability of the QS over a prolonged period.

14. Challenges
Weakness in many approaches to drug prevention that are planned, implemented and evaluated at a micro-level
Evaluated for impact on behaviours and outcomes for individuals and groups, without consideration of characteristics of the whole (complex) system in which they are situated, and which are essential for sustainability and overall programme effects
Prevention programmes/interventions are just one amongst many important ‘implementation objects’

15. Contact http://prevention-standards.eu
Professor Harry Sumnall Public Health Institute