Life Skills Training (LST) - a classroom-based universal prevention programme to reduce the long-term risk of alcohol, tobacco and drugs in middle-school

With respect to individual professionals

• In the initial stages of the Lombardy project, health professionals found it difficult to accept the restrictions and adhere to procedures defined by someone else, and they were unsure of both their role in the LifeSkills Training (LST) project and whether the LST programme met the needs of teachers.
• Teachers had some concerns because they were worried that the programme was not appropriate for their students.
• Teachers were not accustomed to implementing structured classroom activities with high fidelity, and were more used to choosing all aspects of their teaching completely autonomously.
• Teachers had difficulties in implementing a classroom programme that used interactive methods and had multiple sessions, including booster sessions, over a period of several school years. The professional training of educators in Italy focuses largely on specific subject matter and less so on teaching methods. Most teachers in Italy have little experience with cooperative learning and interactive teaching methods. Typically, teachers provide lectures to students and are not familiar with teaching methods that involve facilitated classroom discussions or that provide the opportunity for students to practise new skills

With respect to social context

•The school context in Italy is very fragmented: teachers are often isolated, they do not typically work in teams, and principals often have difficulty in managing teachers. Moreover, schools do not often credit teachers for their work in health promotion; there is a high turnover of teachers; and schools have to face increasingly complex situations, such as the ongoing influx of foreign students. These problems were accentuated by the lack of and squandering of resources.
•The educational standards of Italian school systems are focused on liberal arts and philosophy, and lectures and speculative methods are highly valued.
•Prevention and health promotion are not explicitly included in Italian educational standards and the school curriculum.
•Italian teachers place a high value on autonomy and report high levels of satisfaction in their ability to act independently when choosing their method or style of working and teaching.
•Prevention programmes in Italy are typically not as highly structured and prescriptive as the LST programme. Very few programmes use manuals and lists of activities; instead, in practice, they typically involve a series of relatively unstructured discussion points for teachers to incorporate into their lessons.
•The prevention approach is highly influenced by ideological issues, and it is difficult to value the professional and pragmatic point of view in some cases.
•The strong role of families and their values makes it more difficult for schools to have a role in health promotion and prevention.
•There is a different alcohol culture in Italy from that in the USA, where the programme comes from. Italy belongs to the so-called ‘Mediterranean drinking culture’ (or ‘wet drinking culture’), in which moderate alcohol consumption (particularly wine) is considered normal and is part of daily life and family meals. For example, children are often given diluted wine with meals, and the perception is that there are few psychosocial problems regarding alcohol misuse.

With respect to organisational and economic context

• Differences among cities regarding prevention activities.
• Diffusion of many prevention activities without evidence of their effectiveness.
• Squandering of resources.
• Schools’ requests for ineffective activities (e.g. testimonials, talks from experts).
• Increasing levels of inequality.
• A health-promoting schools network has been established just recently, and it provides a fundamental framework for evidence-based programmes.
• The school organisation is fragmented: primary school is focused on educational goals, middle school is a grey area and secondary school is focused on subject goals.

With respect to individual professionals

• Initially, commissioners struggled with the American version of the programme and would not consider implementing the programme until a UK adaptation was complete. Other obstacles included a lack of understanding of social and emotional learning programmes within the school setting — no one wanted to take ownership of or responsibility for whether it was health or education. Individuals could not understand that, if we improve children's social competence, this will improve a range of outcomes for children including health and education.
• Teachers are under so much pressure within the school setting that they initially saw the programme as extra work and not as a way to make life within their classroom easier.

With respect to social context

• Schools across the regions having varying budgets, with some schools having no money to implement programmes
• Variations in the programmes implemented across the regions and a lot of schools taking on free non-evidence-based programmes when they were not necessarily the right programmes to be implementing in their schools — no outcomes
• No guidelines for schools on what to implement
• Lack of understanding of evidence-based programmes within health and education departments
• Personal development being mandatory within education systems, but there being no accountability regarding whether schools complete it
• No recognition for the importance of this type of work, which is academic focused

With respect to organisational and economic context

• Northern Ireland has no government, so school budgets have been frozen.
• Social and emotional programmes such as LifeSkills benefits are cross-cutting, which is to their detriment, as no department wants to take responsibility for it.

With respect to individual professionals

There were three obstacles:

1. Teachers did not always have enough time to follow the training and deliver the programme.
2. Another obstacle was the continuity; the programme is not a structural part of the curriculum.
3. We, as developers and researchers, are always dependent on grants.

With respect to social context

We developed a programme for all groups. This was a challenge, because everyone has to recognise themselves in the programme. The teachers received training in which they were able to practise this.

With respect to organisational and economic context

In high schools, only a few teachers follow the training and deliver the programme. An obstacle is that not everyone in the school knows about the programme and that management does not always support the practical conditions, such as providing a classroom and time to deliver the programme, and time for preparation.