Challenges with implementing effective school-based prevention – the Estonian experience

In today’s contribution, Karin Streimann, senior specialist of child and adolescent health at the Estonian National Institute for Health Development, describes one of the activities that her Institute undertakes to improve the quality of school-based substance use prevention in Estonia. She also reflects on some of the lessons that she has learnt along the way.

According to Brotherhood & Sumnall (2011), many people wrongly believe that drug prevention means informing young people about the effects of drug use. In reality, the focus of drug prevention should be on strengthening protective factors and reducing risk factors associated with higher likelihood of substance use (National Institute on Drug Abuse 2010). As social contexts influence substance use (Galea, Nandi & Vlahov 2004), measures to influence the school as a social setting are an important part of substance use prevention. That could include a combination of activities such as increasing the school engagement and connectedness, partnership between school and parents and policies to reduce substance use.

However, it is still a common practice in Estonian schools to conduct lectures about the dangers of substances or to invite ex drug-addicts to schools to talk with children. Teacher’s relative lack of knowledge about what is effective in prevention and their personal experiences can offer some explanation to the current situation. Firstly, prevention is not taught for educational science graduates in Estonian universities and continuing teacher training does not reach all the teachers nor does it require teachers to educate themselves specifically about prevention. Secondly, school personnel consider fear-based approaches effective practice mainly because of the immediate emotional reaction they receive from students. In addition, many schools do not have support specialists such as psychologists or social pedagogues who would possibly know more about prevention.

Teachers and schools have many responsibilities and it is understandable that they cannot be experts in every field; that is why our aim is to teach school personnel to use those prevention strategies that are proven to reduce youth substance use.

We offer seminars to schools to help them conduct effective drug prevention…

During the last 1.5 years, the National Institute for Health Development, together with the Estonian Police and Border Guard Board, has organized seminars for school personnel with the aim to invite them to come together and discuss how they can effectively prevent substance use among school students. From each school at least 3 people have to take part in the event and one of them should be a member of school management. The goal is to increase the groups’ capabilities to work together as teams and use evidence-based practices in their everyday work. Our second goal is to introduce the guidelines on how to prevent substance use and manage substance-related incidents. The guidelines for schools include theoretical background information and practical tools that schools can use (e.g. to evaluate their current situation or analyse their action plan for substance-related incidents).

We use a simple illustration in the trainings and describe drug prevention at schools as a chair with 4 legs – you need to have each of the legs for the prevention to be effective. Those four legs consist of:

  • creating a safe and supportive environment at school (e.g. increasing the sense of belonging and feeling connected);
  • establishing substance-related agreements (and we emphasize the word “agreement” rather than “rule” as students should be involved and active participants in making agreements, not just told what not to do);
  • positive partnership between schools, parents and guardians;
  • strong partnership and cooperation with community.

The format of the event gives the teams time to analyse what they already do and what should they be focusing more on.

… but there are some challenges

So far teams from more than 60 schools have taken part in the events. Based on my experience as one of the trainers I would like to bring out some difficulties that we have encountered and lessons we have learned.

In my experience the quality of prevention at schools is related to the quality of prevention within the same community. We bring together school teams from the same communities and based on how prevention is viewed and dealt with in that community some seminars are very productive and some are not.

One part of the seminar is to list the activities that schools are currently doing in the field of prevention. Often they tell us that they invite someone else to speak with students once or twice a year, for example a charismatic lecturer sharing shocking stories or ex-addicts sharing their personal experiences, sometimes even through the theatrical performance. However, Ruiter, Kessels, Peters & Kok (2014) highlight that presenting threatening health information is not effective and should be replaced with different behaviour change methods.

In my opinion prevention is sometimes viewed as a responsibility of “others” and less thought of as something we can all work on. For example, sometimes school representatives tell us that parents, communities or the state should be doing more. I completely agree with that statement in the sense that prevention has to take place in all different settings and that schools cannot handle all the responsibilities by themselves. That is why we also emphasize in the seminars ‘cooperation and partnership’ as a key point in prevention. I also strongly feel that we can always do a little bit more on our own rather than lay the blame or burden on others.

Another challenge is that the representatives from schools can have very different expectations about the training. In the context of drug prevention, school personnel often expect to see or smell real drugs, to hear stories about incidents and to get a thorough training about the effects different substances have on people. They can be surprised regarding the actual contents of the training.

Sometimes I have felt frustrated at the end of the seminar as the balance between preventing problems before they occur and handling incidents has been off. In some seminars the main focus for the schools is on how to deal with incidents rather than how to systematically prevent substance use in the long run. It has been difficult to bring the importance of prevention back to focus.

Thinking about solutions

I would like to offer some possible solutions for improving the situation. The first option would be to bring the teams together several times per year to discuss what they have done in between. Currently, each school participates only once in our seminars but I suggest that follow-up meetings would help to change the real practice and bring long-term results. I think it is a valuable experience for the schools to take time to discuss the topic, share experiences and develop new ideas. The second solution would require improving the teacher training: including basics of health promotion and prevention science in the curriculum.

Bühler & Thrul (2015) concluded in their comprehensive report that the emotional education approach cannot be recommended. Based on our experiences in Estonia, it is still widely spread practice. How is the situation in other countries? Recommendations on how to improve the situation and what has been done are very welcome!

About the author:

My name is Karin Streimann. I work in the Estonian National Institute for Health Development as a senior specialist of child and adolescent health. My work focuses on drug prevention among young people, mainly at the universal level and in school setting. I am also a first year PhD student at Tallinn University and my aim is to conduct an effectiveness study on a universal classroom-based preventive intervention (PAX GBG) in Estonia. You can contact me by e-mail: karin.streimann[at]tai.ee.

References:

Bühler, A., Thrul, J. (2015). Prevention of addictive behaviours. Updated and expanded edition of Prevention of substance abuse. European Monitoring Centre for Drugs and Drug Addiction.

Brotherhood, A., Sumnall, H.R. (2011). European drug prevention quality standards. A manual for prevention professionals. European Monitoring Centre for Drugs and Drug Addiction.

National Institute on Drug Abuse (2010). Preventing drug use among children and adolescents: A research-based guide for parents, educators and community leaders (2nd edition). Maryland, USA.

Galea, S., Nandi, A., Vlahov, D. (2004). The Social Epidemiology of Substance Use. Epidemiologic Reviews, 26 (1): 36-52.

Ruiter, R.A.C., Kessels, L.T.E., Peters, G.J.Y., Kok, G. (2014). Sixty years of fear appeal research: Current state of the evidence. International Journal of Psychology, 49 (2): 63-70.


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