Tú decides – It´s Up To You - a school-based dependency prevention programme for youth focusing on drug initiation and use
At a glance
Country of origin
- Spain
Tú Decides: It´s Up To You aims to enable teenagers to make informed and responsible decisions regarding the use of drugs in relation to the other problems typically affecting this age group. It seeks to support students in the anticipation of realistic choice situations. It also targets problematic use of the internet and social networks. It is based on social influences, taking into account the peer group influences (peer pressure) and the affective and cognitive factors that intervene at the time of decision-making and problem-resolution.
Keywords
No dataLinks to this programme in other registries
Implementation Experiences
Read the experiences of people who have implemented this programme.Contact details
Amador Calafat
Email: calafatfar[a]gmail.com
Email: calafat[a]irefrea.org
Miguel Amengual
Equip de Promocio de la Salut. Servei d'Accio Social i Sanitat. [Health Promotion Team. Health and Social Action Service]. Majorca Island Council.
Street address: Calle General Riera, 67
Postal code: 07010
City: Palma de Mallorca
Country: Spain
Phone: +34 971 761121
Fax: +34 971 761746
Email: mamengual[a]cim.net
Overview of results from the European studies
Studies overview
The programme has been evaluated in three studies in Spain: (i) a quasi-experimental study (1984) in Mallorca conducted in 15 schools among 261 students, four months after the programme ended; (ii) an RCT (1988) in Baja, conducted in 12 schools among 376 students, 12 months after completing of the programme; and (iii) a quasi-experimental study (doctoral thesis, 1985) in San Just Desvern and Viladecans, conducted in two schools with randomly selected classes, among a small sample (n= 84 students in both groups), with the post-test conducted four months, one year, and two years after completing the programme.
The first study (QED) found that the intervention group’s consumption was below the mean of the control group. There was significant reduction in getting drunk. There were significant increases in knowledge about the types of drugs (higher in the intervention group than the control group), and about the consequences of substance abuse. Attitudes towards future drug use were descriptively analysed, the questionnaire was not sufficiently aimed at measuring comprehension of external influences on use. There was an increase in acceptance of social and institutional control mechanisms related to substance use, reduction in getting drunk during the last six months, and reduction in money spent in alcohol. The results indicated that high-risk students were not/less affected by the intervention.
The second study (RCT) found that the control group significantly increased alcohol and tobacco use, and the intervention group remained at the same level. There was an increase in more rational reaction to drugs, less aggressive reaction towards measures of control (law or adults) among intervention group. There were less favourable attitudes toward drugs among intervention group, however there was no effect on decision-making. Similarly the high-risk group was less/not affected by the intervention. Only non-consumers maintained their non-use attitude while users did not reduce their use (the control group participants did increase their use).
The last study (doctoral thesis/QED) found that the intervention group showed big preoccupation with the health risks before use and this seemed to influence actual use. Smoking decreased in post-test but increased in follow-up one year after. There was no significant decrease in drug use in the intervention group, but there was an increase in the control group (the programme had an influence). At 4 months there was a decrease in alcohol consumption, decrease in smoking and weekend smokers, but not the daily smokers. Two years after, there is a slight increase in new drinkers in intervention group, but significant increase in control group. There were no iatrogenic effects.
Countries where evaluated
- Spain
Characteristics
Protective factor(s) addressed
- Individual and peers: clear morals and standards of behaviour
Risk factor(s) addressed
- Individual and peers: peers alcohol/drug use
Outcomes targeted
- Other educational outcomes
- Substance use
- Alcohol use
- Use of illicit drugs
- Smoking (tobacco)
Description of programme
Tú Decides programme is a school-based dependency prevention program that targets youth aged between 12 and 17 years, the critical age for drug initiation and drug use. It is based on social influences, taking into account peer pressure and the affective and cognitive factors intervening at the time of decision-making. It consists of three manuals (teachers, students and parents) that contain all the information necessary for its application. The manuals approach the themes through comics and various activities.
The programme is provided by trained teachers to students in two-hour sessions, one per each unit (8 hours in total), over the course of four months. The programme consists of 6 modules: (1) What about drugs? (2) A way to start. (3) Ana has fun. (4) What do you connect to (about the use of the internet and social networks)? (5) Two versions of the same story. (6) How do my parents come in? It includes strategies aiming at awareness, psycho-education, training of parental skills, leisure activities, and teacher training. It aims to encompass the whole school community: students, teachers, psychologists and parents. There are also four after-work sessions to parents and guardians, which are led by school psychologists.
Teachers and psychologists undergo a mandatory 14 hours on-site training before the implementation of the programme; the training is accredited by the Pedagogical Scientific Council of Continuing Teacher Training. Monthly follow-up meetings and monitoring through web platforms are organised to follow progress and evaluate the training sessions, the modules and the sessions with the students.
The programme is based on the Health Belief Model (Rosenstock, 1974) that focuses on health decision making, reflecting on the external factors (supply, experimentation, etc.) and internal factors (self-esteem, beliefs, etc.). The decision to use a particular substance depends upon a person’s capacity to make responsible decisions, and the programme offers practical preventive education. The programme can be adapted to non-school environments, provided that continuous work can be carried out with the participants.
Implementation Experiences
Contact details
Amador Calafat
calafatfar[a]gmail.com
Main obstacles
With respect to individual professionals
About 12 % of teachers say that they have difficulties in dealing with the programme’s interactive methodologies in class. Several follow-up studies have also demonstrated the difficulty that some teachers have in maintaining ‘active neutrality’ (that is, ensuring that their opinion, for example in favour of or against consumption, does not manifest itself).
It is also important to note, as with many programmes, that over the years teachers become less motivated to continue with the programme if there is not adequate support.
With respect to social context
The programme is generally well accepted by teachers, schools and families. The problem usually relates to how to ensure the continued support of the educational leaders of the municipality or region in which the programme is intended to be implemented. Although it is not an expensive programme to implement, there are sometimes other programmes already in operation or it is thought that it is better to have a portfolio of many programmes instead of only programmes that are proven to be effective.
With respect to organisational and economic context
The programme is free. Therefore, problems linked to economic issues are minor, but some costs are inevitable, for training, materials and the monitoring of the teachers who implement the programme. Problems are not usually encountered at the beginning, when the programme is launched, but after a few years. At this time, there is a tendency to decrease both organisational and economic efforts.
In any case, a large organisational structure is not required for the development of the programme.
How they overcame the obstacles
With respect to individual professionals
During the training period, teachers are invited to participate in interactive techniques (role playing etc.) to ensure that they feel comfortable and are trained in the interactive techniques necessary for the implementation of the programme.
When follow-up sessions are conducted, the teachers’ behaviour is reviewed both in the use of interactive techniques, new information and new pedagogical tools and in the maintenance of neutrality and trying to offer the necessary help.
To ensure that the programme continues to be relevant, there must be a supervisory team that transmits the fact that the programme is of interest to the community, that introduces content or complementary techniques, with periodic meetings between the teachers who implement the programme, etc.
With respect to social context
The decision to adopt evidence-based programmes requires increased awareness that only programmes that have proven to be effective should be implemented. This is a long process and in the meantime each case must be resolved individually based on contacts and by publicising the programme.
With respect to organisational and economic context
Each situation is different and therefore the ways in which the problems that arise are overcome vary. As the programme is free, with no charge for its implementation, many of the solutions depend on the local or regional institutions responsible for prevention.
Lessons learnt
With respect to individual professionals
Training for the programme has changed from theoretical training to much more practical and interactive training. At the same time, the duration of initial training has been reduced and the need for the follow-up of teachers who carry out the programme has been reinforced, to support them and to ensure that they complete the training.
With respect to social context
The culture of evaluation and the effective use of public resources is important. Often, programmes that are already being implemented or that are easier to implement are preferred, regardless of their efficacy. There is not much interest in prevention in general.
Improving or changing this situation depends not on the specific efforts of those responsible for a programme but, rather, on wider changes.
With respect to organisational and economic context
There should be a requirement that only evaluated programmes can be implemented.
In particular, in the development of this programme, it is important that the minimum organisational and economic structure required to keep the programme alive is adopted.
Strengths
The various process evaluations show that the programme is well accepted by schools, teachers and students. It is interesting to see how it has expanded in various regions of Spain and in other countries even though there is no central promotion structure or economic interest. It should also be noted that, although it was designed a long time ago, it has managed to maintain levels of acceptance over time, with small adjustments being sufficient (such as incorporating non-chemical dependencies).
It needs a minimal structure of support (preferably external to the school) to ensure its operation. Evaluations also highlight the ease with which teachers can get involved with the implementation of the programme and the high degree of loyalty to the programme year after year, provided a minimum level of follow-up of teachers’ work is maintained.
Weaknesses
The programme usually works better when teachers have volunteered to implement it.
Some teachers have expressed that they feel uncomfortable implementing interactive techniques in class.
The involvement of parents in the programme is always complicated, with varying levels of success (although this is something found with other programmes also).
As with other programmes, it is important that there is supervision of teachers’ work to ensure adherence to the programme as well as its continuity.
Opportunities
We must move towards a situation in which only evaluated programmes are implemented and subsidised. The shortage of such programmes should be an advantage for the adoption of this programme, especially given its high level of acceptance and the fact that few resources are required to support it.
Threats
There is little interest in investing in prevention. Instead, a disinterest in prevention, from social, professional and policy points of view, is detected. Consequently, there is no a great interest in adopting or evaluating new programmes. This trend should be reversed.
Recommendations
With respect to individual professionals
There should not be major problems in adapting the programme for other countries. There are previous experiences of adapting the programme to different contexts, such as for Portugal and Argentina, and no problems have been recorded so far. The material that is used, as well as the accompanying printed comics, would need to be adapted to a certain extent. The teachers of the schools that are going to implement the programme are not expected to have very different characteristics, for the purposes of the needs of this programme, from teachers in Spain.
We believe that the programme is easily adaptable to different contexts.
With respect to social context
The programme presents an active neutrality and does not oblige the school, family, students or teachers to adopt a specific ideological position a priori. But neither does it lead people to feel that they cannot or should not do anything, because in fact it is a decision-making programme. So far, this has not caused any problems and it does not seem to have caused problems in other social contexts either.
With respect to organisational and economic context
It is not a particularly demanding programme, neither in terms of organisational complexity nor in terms of economic requirements.
It is recommended that implementation is started progressively, initially recruiting mostly volunteer teachers. We do not recommend a very long initial training period, but recommend concentrating on following up each teacher during the period in which each teacher implements the programme. This allows training to be completed, questions to be answered, the fidelity of implementation to be reviewed and the continuity year after year of the programme to be ensured.
