Four-fold prevention: strategies to prevent substance abuse among elementary school-aged children

Professional School Counseling, Oct, 2001 by J. Kelly Coker

Education to prevent child and adolescent substance abuse has been the focus of a variety of school-based programs and approaches through the last three decades (Kreft, 1998). In the early days of prevention education, young people were shown what drugs looked like, with warnings about what evil would befall them if these drugs were taken. In the 1980s, peers and adults were portrayed as vicious culprits exposing innocent children to drugs in the "just say no" campaigns. The more recent focus has been on concurrently teaching refusal skills and bolstering self-esteem with the belief that these will suffice to prevent experimentation with drugs. The problem with all of these prevention approaches is that there is no firm evidence that they work (Kreft, 1998; Lynam et al., 1999). Kids continue to use drugs, and at earlier and earlier ages. The use of alcohol among teens has remained relatively stable in the past few years, with 51.3% of high school seniors, 38.8% of 10th graders, and 24.6% of 8th graders reporting some use in the last 30 days. In addition, the use of cigarettes among girls has risen sharply, and the use of marijuana has more than doubled since 1991 (St. Pierre, Mark, Kaltreider, & Aikin, 1997).

The professional school counselor is left to search out effective and proven prevention programs for addressing substance-abuse issues in the schools. Research has suggested that prevention programs that include an examination of relevant social and environmental factors may be more effective at preventing alcohol and drug use than programs that focus primarily on refusal skills (Homonoff, Martin, Rimpas, & Henderson, 1994).

In a prior study (Coker & Borders, 2001), the author and a colleague examined trend data gathered from the National Education Longitudinal Study (U. S. Department of Education, 1996) in an attempt to identify those environmental and social factors that appeared to guard against substance-using behavior, specifically problem drinking. The results identified four salient features: (a) positive, supportive relationships with parents; (b) involvement in community-based activities; (c) a positive school climate; and (d) relationships with positively influencing peers. Scales (1998), in a study through the Search Institute, found comparable features.

The 4-Fold Prevention Program

This article describes a substance-abuse prevention program, 4-Fold Prevention, designed to specifically focus on four primary areas of social support--parents, schools, communities, and peers. This program enhances positive and supportive relationships among children and influencing adults and peers by opening the lines of communication about attitudes and beliefs regarding alcohol and other drug use. The 4-Fold Prevention program is nested in recent and relevant research suggesting that enhancing relationships with positively influencing adults and peers during pre-adolescence significantly impacts derisions to not use alcohol and drugs (Homonoff et al., 1994; Weishew & Peng, 1993).

A lesson plan and a student workbook provided the structure of the program. (See Table for an abbreviated lesson plan for the six sessions.) The lesson plan included group activities centered around discussions of family relationships, community opportunities, positive peer relationships, feelings about school and drug information. The program also contained outside-group activities in which the students interviewed parents, school faculty, community members, and other peers about drug attitudes and beliefs. In addition, students completed guided activities with their identified team, which consisted of a family member, a school member, a community member, and a peer member. A student workbook was provided to each participant and was used to help guide students through both the in-group and outside-group activities.

Program Evaluation

The author completed a pilot test of the 4-Fold Prevention program with elementary school-aged students from an urban, at-risk elementary school (K-5) in the southwestern United States. Two fourth grade classrooms were selected for participation. Nine students participated in the program over a 6-week period and completed pre- and posttest instruments. Thirteen students from the two classrooms acted as a control group and also completed the pre- and post-test instrument. The efficacy of the program was evaluated through the collection of both qualitative data and quantitative data. Qualitative data were gathered through observation, interviews, and examination of student responses in the student workbook. Quantitative data was gathered from a pre- and post-test instrument.

Qualitative Evaluation

Ongoing observational data were gathered after each group meeting with participants. Participants were also interviewed after the program for their reactions to the experience, and their responses and writings in the student workbook were examined for relevant information.

Participants were asked to interview a teacher or counselor at their school regarding perceptions about youth alcohol and drug use [Lesson 2]. The majority of students chose their classroom teacher. Most participants indicated they enjoyed talking to their teacher about something other than "schoolwork." Many students also expressed an interest in having their teacher focus more on alcohol and drug issues in the classroom. As part of their examination of school climate, participants were asked to brainstorm ideas to share with the principal on how to make their school more "kid friendly." Participant ideas for enhancing school climate at their school included: creating peer mediation groups so older students could help younger students resolve conflicts; addressing issues of violence, gangs, and "bullies"; and having small group discussions within classrooms about drugs, alcohol and violence. Student suggestions were consolidated in a letter from the group members to the principal. The participants were excited about their ideas being seen and considered by their principal.