Ccsa0117812009 - e 1

BUILDING
on Our
STRENGTHS
Canadian Standards for Youth Substance Abuse Prevention

A Guide for Education and Health Personnel
A component of CCSAs Drug Prevention Strategy for Canadas
This document was published by the Canadian Centre on Substance Abuse (CCSA). Suggested citation: Canadian Centre on Substance Abuse. (2009). Building on our strengths: Canadian standards for school-based youth substance abuse prevention: A guide for education and health personnel (Version 1.0). Ottawa, ON: Canadian Centre on Substance Abuse. This is a living document, which CCSA may revise and update to reflect the latest evidence and research. Copyright 2009 by the Canadian Centre on Substance Abuse (CCSA). All rights reserved. CCSA, 75 Albert St., Suite 500 Ottawa, ON K1P 5E7 Tel.: 613-235-4048 Email: info@ccsa.ca This document can also be downloaded as a PDF at www.ccsa.ca Ce document est galement disponible en franais sous le titre : Consolider nos forces. Normes canadiennes de prvention de labus de substances en milieu scolaire. Un guide pour les intervenants en sant et en ducation. ISBN 1-897321-96-1
BUILDING ON OUR STRENGTHs

Canadian Standards for School-based Youth Substance Abuse Prevention
A Guide for Education and Health Personnel
uilding on Our Strengths: Canadian Standards for School-based Youth Substance Abuse Prevention is an initiative proceeding under the leadership of the Canadian Centre on Substance Abuse (CCSA). With a legislated mandate to provide national leadership and evidence-informed analysis and advice to mobilize collaborative efforts, CCSA is a national non-governmental organization working to reduce alcohol- and drug-related harm. The Canadian Standards were developed by a Canadian Standards Task Force with representation from CCSA, its partners and other experts: Doug Beirness (Co-chair), Canadian Centre on Substance Abuse Shiela Bradley, Alberta Alcohol and Drug Abuse Commission Heather Clark, Canadian Centre on Substance Abuse Asma Fakhri, Canadian Centre on Substance Abuse Marvin Krank, University of British Columbia, Okanagan Christine Lebert, Centre for Addiction and Mental Health Colin Mangham, Drug Prevention Network of Canada Janice Mann, Canadian Centre on Substance Abuse Rhowena Martin, Canadian Centre on Substance Abuse Brian McLeod, Strong Heart Teaching Lodge Rita Notarandrea, Canadian Centre on Substance Abuse David Patton, Government of Manitoba Gary Roberts, Gary Roberts and Associates Art Steinmann (Co-chair), Art Steinmann and Associates David Wolfe, Centre for Addiction and Mental Health
Building on Our Strengths was reviewed for ease of understanding and relevance to daily realities in the field by a panel of end users and front-line workers in youth substance abuse prevention. The Canadian Standards Task Force selected the following panel members: Claire Avison, Pam Benson, Diane Buhler, Sharon Cirankewitch, Les Dukowski, Mark Fudge, Christina Garcia, Katie Glover, Patricia Keeble, Lori Kleinsmith, Susan Lalonde-Rankin, Sarah Lambert, Mary McComber, Erin Moore, Naomi Parker, Dan Reist, Pat Sanagan, Velma Shewfelt and Lesley Whyte. The Canadian Standards Task Force would like to acknowledge the contribution of the Canadian Association for School Health (CASH) through their provision of School-based and school-linked prevention of substance use problems: A knowledge summary as a background document in the initial development stages of the Canadian Standards. The school-based Standards are one of several sets of standards to be developed with the aim of strengthening the quality of youth-oriented drug prevention programs in Canada. This initiative is also part of CCSAs Drug Prevention Strategy for Canadas Youth, launched in 2007. This national strategy is CCSAs response to a call to address the needs of children and youth in the National Framework for Action to Reduce the Harms Associated with Alcohol and Other Drugs and Substances in Canada (2005).
Version 2.0 of Building on Our Strengths: Canadian Standards for School-based Youth Substance Abuse Prevention was released June 21, 2010. To view this revised edition, visit http://www.ccsa.ca/ Eng/Priorities/YouthPrevention/CanadianStandards/ Pages/default.aspx.
TABLE OF CoNTENTS
Section One: An Invitation How to use this resource Schools and student substance abuse Why schools need to address student substance abuse Defining school-based substance abuse prevention Section Two: Canadian Standards Guiding principles The Standards A. Assess the situation 1. Account for current activities 2. Learn relevant protective and risk factors 3. Determine local substance use patterns and harms 4. Clarify perceptions and expectations 5. Assess resources and capacity to act B. Prepare a clear and realistic plan 6. Ensure goals address relevant factors and priority harms 7. Engage students in design of the initiative 8. Determine areas of leadership, cooperation and support C. Build capacity and sustainability 9. Conduct ongoing professional development and support 10. Address sustainability of the initiative 11. Connect with parents and community initiatives D. Implement a comprehensive initiative 12. Cultivate a positive health-promoting school climate for all 13. Deliver developmentally appropriate classroom instruction at all levels 14. Organize targeted activities within a comprehensive continuum 15. Prepare, implement and maintain relevant policies E. Evaluate the initiative 16. Conduct a process evaluation of the initiative 17. Conduct an outcome evaluation of the initiative 18. Account for costs associated with the initiative Section Three: Workbook 10-minute reflection In-depth review Section Four: Appendix Methodology Bibliography
4 5 6 6 7 9 9 14 15 15 16 16 17 18 20 20 22 22 24 24 25 27 29 29 30 33 35 37 37 38 39 41 41 43 63 63 66
BUILDING ON OUR STRENGTHs: Canadian Standards for School-based Substance Abuse Prevention. Version 1.0
1.
SECTION ONE:
SECTION ONE: An Invitation

will be effective. However, the only way a school can be certain its efforts have had a positive effect is to evaluate the initiativea major theme these Standards convey. The best route to strengthening school substance abuse prevention practices is through a team approach, ideally a health-promoting group comprising key members of the school community. This Canadian Standards resource is addressed to these school or board staff; it is also directed to addictions prevention, public health, and related professionals who can add value to school teams and support prevention efforts in other ways.i
The aim of these Standards and accompanying resources is to help schools strengthen the effectiveness of their prevention and health promotion efforts by providing: a) a benchmark of optimal performance; and b) support and guidance to pursue improvements. The 18 Standards have been informed by research on approaches that have shown effectiveness (for more information on methodology see Section 4). The Canadian Standards are designed for initiatives that are implemented in schools rather than programs or manuals that sit on a shelf . The more fully a school achieves these standards, the more likely its initiative Schools across Canada implement a variety of activities to prevent student substance abuse.ii Are these efforts effective? This is difficult to know since most have not been evaluated, but what is clear is that all efforts can be strengthened. The Canadian Standards for School-based Youth Substance Abuse Prevention aim to do precisely that. They represent an invitation to build on the work already underway in school settings across the country to prevent substance abuse. By accepting this invitation, you can help more students in your school or district avoid substance use-related harms, succeed academically and lead healthier, more productive lives. You may be concerned that responding to this invitation will distract you from your primary focusstudent learningbut it need not. The best substance abuse prevention efforts are woven into the core mission of health-promoting schools. Administrators and staff in such schools understand that:
the many attributes of a health-promoting school help prevent substance abuse; efforts to prevent substance abuse and promote student well-being contribute directly to academic success; and effective substance abuse prevention doesnt necessarily mean working more, but refocusing resources to what has been shown to work.
The best substance abuse prevention efforts are woven into the core mission of healthpromoting schools.
i ii
Note that these Standards do not address school treatment-related activities (i.e., assessment, counselling, referral to treatment, aftercare). This document uses the term substance abuse to refer to problematic use of substances. For discussion on this terminology, see Section 4.
Canadian Centre on Substance Abuse 2009. All rights reserved.
Numerous drug prevention programs are available in this country both free of charge and on a commercial basis. Many of these are of sound quality, but unless they contribute to a whole-school approach, the effect will be piecemeal and less effective.1 A dominant theme of these Standards is that prevention is best achieved through broader ongoing processes rather than any individual programthe how is at least as important as the what. 2 Its most helpful to view prevention as a mind-set, a culture, a way of doing things and everyone has a role. The Canadian Standards provide a framework for assessing your initiative through a health-promoting school lens; they reflect the latest evidence and the best thinking of Canadian experts. The immediate goal of these Standards and the related resources is to help schools strengthen the effectiveness of their prevention and health promotion efforts. The longerterm aim is to reduce substance abuse and promote wellbeing among students in Canada. Whether you are part of a school team, a public health practitioner, counsellor, administrator, policy maker, program developer or researcherwhether you are developing or adapting an initiative or reviewing your existing work in this areayou are invited to take time to consider how you might strengthen your efforts to prevent substance abuse. In these Standards, the term initiative is used instead of program or project to reflect that prevention should become infused into a schools everyday work rather than viewed as a separate, time-limited add-on. In this resource youll find: a quick checklist for reflecting on your substance abuse prevention efforts to date; and a more in-depth tool for reviewing and assessing those efforts.
The term initiative is used instead of program or project to reflect that prevention should become infused into a schools everyday work rather than viewed as a separate, time-limited add-on.
HOW TO UsE ThIs REsOURCE
As schools across the country have different priorities and capacities, this resource provides a workbook (Section 3) with three options for strengthening your work: Level 110-minute reection: The checklist in the workbook in Section 3 will help you quickly assess the strength of your school-based prevention initiative and consider whether resources are being spent in the best possible ways. Level 2In-depth review: This more thorough selfassessment will indicate where you can further tailor your initiative. Bring your team together to methodically review your prevention initiative and identify strengths and areas to improve. Level 3Assessment by the National Panel on Canadian School-based Youth Substance Abuse Prevention Standards: After youve prepared the necessary documentation, you can submit your materials to the National Panel for assessment and guidance. Participating initiatives that demonstrate a commitment to strengthening their efforts will be included in CCSAs Database of Evidenceinformed Canadian School-based Youth Substance Abuse Prevention Initiatives. This not only demonstrates your commitment to continuous improvement but also provides direction and inspiration to others wishing to strengthen their initiatives.
This resource also guides you in: having your school-based prevention activities assessed by a national panel; and accessing web-based information on Canadian school programs and practical resources to support your efforts.
SChOOLs AND sTUDENT sUBsTANCE ABUsE Why schools need to address student substance abuse
The first experience with substance use is usually during adolescence, with alcohol being the most common by far, followed by cannabis and tobacco. Although many adolescents who use substances do not encounter problems as a result, even infrequent use can have harmful consequences due to intoxication. Those who use frequently, heavily or in hazardous contexts are more likely to experience a range of immediate and longer-term harms. Some of the immediate effects of substance use interfere directly with the missions of schools. Although the links between academic performance and substance use are not completely understood, it is generally agreed that adolescents with low academic grades are more likely to have substance use problems, and vice versa. Substance involvement affects school performance in a number of ways: 3 4 5 A student who is intoxicated or hung over during the school day learns less, and an ongoing pattern of using to the point of intoxication will interfere with academic performance. Young people have not reached full maturity physically, psychologically or socially, and substance use may affect brain development and interrupt crucial developmental processes. Student substance use is often associated with other social or emotional difficulties and disruptive behaviour that affect the social and academic environment for others.
School-based prevention efforts, when well designed and delivered, can help students not only avoid these various problems but also achieve their maximum potential and thrive. That said, schools should not be expected to act alone in reducing substance use harms in their communities because: Numerous factors that promote youth development or, on the other hand, contribute to substance abuse fall largely outside school boundaries (such as family cohesion, media influences, access to alternative activities, community resources and societal values). Many of the immediate harms (e.g., vehicle crashes, vandalism) as well as longer-term harms (e.g., family, legal, occupational problems) are of concern to the general community. School activities are most likely to have the desired effect when they are complemented by or linked to efforts in the community, ideally within a broader strategy.
Early or frequent substance use often encourages movement into a peer and social network that promotes continued and escalating substance use while at the same time discouraging engagement with school and other conventional institutions.
School-based initiatives are best situated in broader, community-wide strategies that try to reach young people in other settings such as families, recreational environments, workplaces, and nightlife and social situations. Effectiveness is most likely when these community settings infuse health-promoting aims into their core missions. Ongoing collaboration among various efforts further increases the likelihood of effectiveness by reinforcing particular norms (e.g., connectedness of young people to adults and community institutions), enabling resource-sharing and preventing fragmentation.
Defining school-based substance abuse prevention

Prevention and health promotion initiatives are planned efforts directed to whole school populations or definable sub-groups. They may aim to broadly improve student wellbeing (and by doing so prevent substance-use problems) or explicitly aim to prevent or reduce substance abuse. To be considered a prevention initiative under these Standards, a broader initiative (e.g., a peer leadership initiative) must refer to substance abuse prevention in its documentation and evaluation. School-based substance abuse prevention is defined by the author as: any planned initiative (policy, program or practice) at least partially based in a school that aims to prevent substance abuse among students or to positively affect factors shown by research to prevent substance abuse.
1. Addressing factors that have been shown to have an effect on substance abuse (protective or risk factors); for example, by improving school climate, increasing effective parent-child communication or reducing the impact of student transitions. 2. Preventing or delaying first use of alcohol, tobacco, cannabis and other substances. 3. Preventing or reducing negative consequences linked to substance use by: a. minimizing the extent of hazardous use among students (e.g., reducing: frequency of use; amount used; use of more than one substance at a time; use in association with driving; unintended sexual activity; use with school work or sports/physical activities); and b. preventing or minimizing the severity of harmful consequences that arise from hazardous use (e.g., car crashes, sexually transmitted diseases, pregnancies, injuries, overdoses, etc.). Prevention initiatives can take various forms. While the scope of possibilities is broad, most school-based prevention initiatives involve one or more of the following: A. Universal classroom instruction for all students in a grade, where substance use education is presented within an integrated multi-issue health education curriculum (classroom instruction is termed universal because it is provided to all students without regard to their relative risk).
Prevention and health promotion initiatives may explicitly aim to prevent or reduce substance abuse or more broadly improve student well-being.
If we dissect this definition, substance abuse prevention can be seen as having one or more of the following goals:
B. Targeted programs for selected students seen to be at risk either because of factors in their lives or their current level of substance use. These initiatives may have a classroom instructional focus or a counselling focus (in school or in the community).
C. Comprehensive or whole-school approaches adding attention to the social and physical environments to a mix of the above (universal classroom instruction and targeted programming or services), best coordinated through policy. D. School-community initiatives through which schools cooperate with others in the larger community (e.g., the municipal government, youth agencies, media outlets, parent groups, etc.) to pursue shared prevention aims. Prevention initiatives generally try to increase knowledge, change attitudes and build life skills relevant to preventing substance abuse. The litmus test of a prevention initiative is whether it leads to a change in substance use-related behaviour (e.g., negotiating a substance use situation on a Friday night). Initiatives need to be evaluated on their ability to change substance use patterns or behaviours, or affect factors known to influence substance use. Current evidence suggests this is most likely to be achieved within a comprehensive health-promoting school approach that includes strong parent and community connections. When everyone in a community sees prevention as their business, positive change is inevitable.
2.
SECTION TWO: Canadian Standards

simply in the classroom, and curriculum is seen to embody everything that promotes students intellectual, personal, social and physical development. Curriculum thus includes not only lessons and extracurricular activities, but also approaches to teaching, learning and assessment, the quality of relationships within the school, and the values reflected in the way the school operates. In a dynamic and vibrant healthpromoting school, participation, empowerment, equity and democratic processes are considered key values.11 A healthpromoting school approach is best seen as a way of refocusing values and activities rather than as a new project.
GUIDINg PRINCIPLEs
The Task Force identified several principles that form the foundation of the Standards. Aspects of these principles find expression in various Standards, and school substance abuse prevention initiatives should be firmly grounded in these.
1. Frame substance abuse prevention within a health-promoting school approach

Research evidence shows that the ability of classroom health instruction to bring about healthier student behaviours on its own is limited.6 7 The most effective classroom drug education programs tend to have, at best, a modest, shortterm effect on student substance abuse.8 Sustained improvements on a range of issues, including academic performance, are more likely through a multicomponent health-promoting school approach.9 The World Health Organization defines a health-promoting school as one that is constantly strengthening its capacity as a healthy setting for living, learning and working.10 According to this approach, the school is seen as a system shaped by structures, policies, relationships and practices. The components of a healthpromoting school approachthe curriculum, a healthy school environment, health services, and parent and community involvementsupport each other in a coordinated fashion for the benefit of students and staff. Broad approaches tap into the many spheres of influence or protective and risk factors at play in the lives of students in a way that classroom instruction alone cannot. In a health-promoting school approach, learning is understood to occur within the whole school rather than
2. Community responsibility, knowledge, and resources are key

Even within a comprehensive school health framework, the dizzying array of student issues todays schools are called upon to address (often with limited resources) is daunting. It is difficult for schools to shed these responsibilities, but it is important to be realistic about what can be achieved. Each school must work from its own unique circumstances its particular assets and challengesto address student health and learning issues as fully as possible. There is no single destination for school health promotion and prevention; it is more helpful to adopt a posture of continuous improvement. No one knows a school as well as those who learn, work and play within it. While support and advice may be drawn from different sectors, it is ultimately staff and students who will bring positive change to the school community. Viewed this way, the best results occur when schools not only refer to research on good practices but also take the time to reflect on and interpret how these apply to their situation.
Best results occur when schools not only refer to research on good practices but also take the time to reflect on and interpret how these apply to their situation.
Acquiring this grounded knowledge takes some added effort and is an ongoing process, but brings a confidence that efforts will be effective. Developing or strengthening an instinct for community reflection and planned, collaborative action is key to becoming a health-promoting school. Prerequisites for such action are trust and mutual respect between staff, students, parents and the community. Over time, this builds assets and resources in the school community that go beyond financial, and the benefit is a growth-oriented, cohesive school community.
3. Give attention to development pathways

In each of our lives, various factors that either increase the likelihood of problems (risk factors) or help us avoid them (protective factors) interact to form a complex web that influences our actions. Some factors are closely related to a risk behaviour (e.g., expectations surrounding cannabis use), while others are more extensive (e.g., sense of connectedness to family and school). Broader factors tend to have an impact on a range of risk behaviours and well-being in general. When the risk factors in a students life become greater than the protective factors, even those students who have coped well in the past may experience problems. The ability to balance risk and protective factors is not determined solely by the nature and number of factors present, but on their frequency, duration and severity, as well as the developmental stage at which they occur (see also the discussion on positive youth development and resiliency that follows). According to the developmental pathways perspective, each life stage presents differing protective and risk factors that play out in a dynamic fashion. This perspective also suggests:12 no single risk factor is directly related to developmental problems such as substance abuse; it is more likely that a combination of factors at a particular life stage combine to place a person at particular risk;
risk may find expression in any of several youth issues (e.g., problematic substance use, mental health problems, teen pregnancy, violence and criminal activity) that share many of the same risk factors and developmental pathways; exposure to risk factors early in life can have a snowball effect, altering the subsequent course of a young persons development; upcoming risk factors tend to accumulate (e.g., weak child-parent attachment at infancy contributes to behaviour problems that affect school performance and engagement with peers)consequently, early life interventions can help prevent a range of later problems; initiatives should place a greater focus on protective than risk factors because individuals and groups tend to respond better when approached to build on their strengths rather than address their limitations or problems;13 and along with early-in-life interventions, interventions early in problem pathways or at points of vulnerability (e.g., new school, separated parents) are advised.
4. Promote positive youth development and resiliency

Most people respond best to help that emphasizes and builds on ones capabilities rather than focusing on deficits and limitations.14 In a positive youth development approach, young people are not seen as passive subjects with problems and deficiencies that need to be fixed, but rather as active agents with inherent capabilities to be drawn out and strengthened. Some general social and emotional capacities (e.g., competence, self-confidence, connectedness, character, caring and compassion) and environmental supports (e.g., safe, welcoming and non-punitive settings, and freedom from stigma, harassment and discrimination) can enhance well-being while serving to reduce the risk of a range of problems. The most effective way to build these personal and environmental capacities is to engage students as partners in school-life initiatives as fully as possible.
10 Canadian Centre on Substance Abuse 2009. All rights reserved.
In schools, a positive youth development perspective is best supported by a drug and health education curriculum that emphasizes active student involvement and relevance, seeing the teacher as a guide rather than an expert (i.e., reflecting a constructivist education philosophy). Active participation means that peer-to-peer activities and discussion are emphasized to help students appreciate various perspectives and find their own meaning in questions concerning substance use and health.15 Beyond the classroom, this perspective challenges schools (and other sectors) to foster environments that encourage youth to become involved and assume increasing responsibility in their own lives and the lives of others. Educators and other adults are called upon to actively and creatively find channels for students to become meaningfully involved in issues that affect them. A positive approach to building individual and system strengths in a school also promotes resiliency in students. Resiliency is the ability to cope with adversity (e.g., living with an alcohol-dependent parent). Everyone possesses some measure of resiliency, which can be strengthened with appropriate social support and a positive school environment. When all the main influences in the lives of children and youth (e.g., parents, schools, out-of-school programs) actively and collaboratively promote positive development over the long term, positive outcomes are likely. An aim is to establish a reciprocal pattern wherein children and adolescents receive support but also give back to their family, school and community. In this sense, this approach has benefits that transcend prevention and health promotion and move toward citizenship and democracy development.
5. Understand and engage diverse student populations

Within any school population are young people with a range of social and cultural backgrounds. Each students personal story presents various events, circumstances and factors, some of which may serve to promote their wellbeing while others may place them at risk. When delivering a universal prevention initiative it is important to be mindful of the diversity that exists in a class or group and to promote understanding of diverse backgrounds and perspectives. Care needs to be taken when targeting particular students for programming to avoid labelling or stereotyping a young personultimately, a youths ability to cope with challenges will be determined by the personal, family, school and community resources that can be brought to those challenges. Evidence does suggest, however, that young people living with the following issues can be at higher risk for substance abuse and other health and social issues and may not be well served by universal approaches: Students with less access to the social determinants of health: A number of factors such as unemployment, low income, and poor working conditions are among a number of determinants of health that are understood to have significant impact on health. Many people in our society experience challenges in accessing resources that can help them lead a healthy and full life. For example, Canadians in the lowest income bracket are much less likely to rate their mental and overall health as very good or excellent compared to those in the highest income group. That said, the relationship between substance use and social determinants is complex and not fully understood. For example, higher-income Canadians tend to drink more, and most students engaged in hazardous alcohol use have average access to these determinants.
11
Sex and gender: Sex and gender (a determinant of health) are important considerations with substance use, both in terms of physiology (sex) and cultural construction (gender, that is, the roles and expectations societies assign to boys and girls, and the experience of femaleness and maleness).16 Girls and women have a lower threshold to the effects of alcohol. Given the same amount of alcohol as young men, young women will become more intoxicated, get intoxicated faster and stay intoxicated longer (worsened still by dieting).17 While the percentage of male and female students who have used various substances has converged and is similar in many cases, males tend to use more frequently and heavily. Nevertheless, young women tend to experience problems and dependence at about the same rate as men.18 Certain protective and risk factors may hold equal importance for boys and girls (for example, social support, academic achievement, poverty) but are expressed in different ways. Other risk factors tend to be more important for girls, such as negative self-image or self-esteem, weight concerns, early onset of puberty, higher levels of anxiety and depression, or boyfriends drug use. Similarly, certain protective factors, such as parental support and consistent discipline or selfcontrol, tend to be more important for girls. Girls may be particularly vulnerable to the influence of peers, friends with problem behaviour, and peer or parental disapproval/approval of substance use.19 Because girls tend to give greater priority to relationships than do boys, they are more likely to judge school culture in favourable terms and express a stronger sense of school belonging and attachment.20 Students with mental health issues: It has been estimated that 15% of Canadian children and youth will experience some form of mental illness (severe enough to cause impairment). The most prevalent mental illnesses in this population are anxiety disorder, conduct disorder, attention-deficit/hyperactivity disorder (ADHD), and depressive disorder. Substance
use may be an attempt to self-medicateto manage moods and feelings (for example, some studies have found adolescents with ADHD symptoms are much more likely to smoke cigarettes),21 but substance use can exacerbate symptoms. Gay, Lesbian, Bisexual and Transgender (GLBT) students: There are indications that GLBT youth need to be viewed as vulnerable to substance abuse, though caution is advised in generalizing findings over a broad cross-section of people estimated to represent 10% of the population. Reasons cited for the increased risk among these young people relate to the added stresses of coping with their sexual identity; sharing their sexual orientation with family, friends and classmates; and general stigmatization. Additionally, there is some evidence that GLBT students who do not face stigmatization (e.g., routine taunting) are at no greater risk of using drugs or experiencing other social/health issues than their heterosexual counterparts.22 Disengaged students: Young people who are not engaged with learning and who have poor relationships with peers and teachers (e.g., are being bullied or have feelings of not belonging) are more likely to experience academic and mental health problems and engage in various health risk behaviours including substance use. Canadian research has found that students with less connection to their teachers are more likely to use marijuana, to smoke, to be sexually active and report depression.23 Students with positive teacher, learning and social connectedness fare best in terms of later mental health and health risk behaviours, and are more likely to have good educational outcomes. Even students who have been suspended or detained yet perceive a connectedness with teachers are less likely to become involved in harmful substance use or other problem behaviours than counterparts who dont have that sense.24 A positive relationship with a family member or another adult can support school engagement.
New Canadian students: The proportion of ethnocultural groups in Canada has increased dramatically over the last few decades, with most recent immigrants arriving from Asia, Africa, the Middle East, and South and Central America (cultures with widely different views on substance-related issues). Young immigrants and refugees who remain engaged with their family and culture can draw protection from those values; however, they may be vulnerable to substance use and mental health problems due to earlier trauma, economic and social disadvantages, isolation and discrimination. Substance use attitudes and practices vary widely between cultures, but there is some indication of generally poor knowledge of the harms linked to substance use among new Canadians. New Canadian parents tend to be less involved in health promotion and prevention programs due to language and cultural factors.25 Aboriginal students: Approximately 4% of Canadians identify themselves as Aboriginal, but within that designation is a diversity of histories and cultures.26 One factor shared by many is the residential school system, which is bound up with a number of other factors (e.g., lack of education, lack of employment opportunities, poverty and low self-esteem) that together have perpetuated a cycle of dependence preventing Aboriginal people, including youth, from participating fully in Canadian society. While a national picture is not available, provincial data indicate that substance use among Aboriginal youth is higher than among their non-Aboriginal counterparts.27Aboriginal youth are over-represented in the youth justice and child welfare systems.28 29 30 (e.g., First Nations youth in Canada are more likely to be incarcerated than to graduate from high school.)31
Understanding that students bring a mix of social and cultural experiences to school, some of which may place students at greater risk for substance use problems, educators and health promoters need to ask themselves: how can we make what we do work for the full range of students in our school? They should specifically consider: whole-school system-level improvements that support all students regardless of background and risk level; initiatives to promote understanding and respect for diverse populations; benefits of targeting children and youth experiencing particular challenges, and weigh them against the possible harms (through labelling); if the decision is made to target or select students in this way, designing the initiative in partnership with those youth for whom the initiative is intended to help; and that many students who binge drink and smoke regularly have average exposure to risk factors and are best served by broad initiatives that focus on reducing hazardous patterns and harms that may arise.32
13
ThE STANDARDs
The Standards combine two functions: quality assessment and capacity building. The 18 Standards in the table that follows provide a benchmark for schools to aim toward with their substance abuse prevention activity. The Standards have been organized according to five phases that can be used to guide a full design and implementation process. Those using this resource may choose to focus on a particular phase; however, attention to the full slate of Standards is recommended because comprehensive action is advised, and the Standards build on and inform each other. The Canadian Standards are supported by various resources to support capacity building around these standards and phases.
A. AssEss
the situation
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
Account for current activities Learn relevant protective and risk factors Determine local substance use patterns and harms Clarify perceptions and expectations Assess resources and capacity to act Ensure goals address relevant factors and priority harms Engage students in design of the initiative Determine areas of leadership, cooperation and support Conduct ongoing professional development and support Address sustainability of the initiative Connect with parents and community initiatives
B. PREPARE
a clear and realistic plan
capacity and sustainability
C. BUILD
a comprehensive initiative
D. IMPLEMENT
12. 13. 14. 15.
Cultivate a positive health-promoting school climate for all Deliver developmentally appropriate classroom instruction at all levels Organize targeted activities within a comprehensive continuum Prepare, implement and maintain relevant policies
the initiative
E. EVALUATE
16. 17. 18.
Conduct a process evaluation of the initiative Conduct an outcome evaluation of the initiative Account for costs associated with the initiative
A. AssEss ThE sITUATION 1. Account for current activities

Before considering a new substance abuse prevention initiative it is important to review existing and recent activities. The review should take note of intentional, planned initiatives as well as the general school climate. If prior and current activities have been monitored, existing documentation may be sufficient for assessment. If not, minutes of staff meetings and student and parent council meetings may contain relevant information. It is always helpful to hear from a range of staff and students during the course of this process. School climate: In recent years, schools have been reminded of the important role of school climate or ethos in contributing to a number of positive outcomes for students and staff. School climate can be difficult to define but has been described as the quality and character of school life, reflecting norms, goals, values, relationships, teaching, learning and leadership practices, and organizational structures.33 A positive school climate can have many benefitsincluding substance abuse preventionso it is important to try to understand the current situation in a review process. Questions to consider include: What do we mean by positive school climate in our school? What is our goal(s) for school climate? Do all students feel safe? Do all students feel connected to the school? What efforts are made to improve connection between students, parents, and teachers? What partners and agencies are involved in and committed to the school?
Has the policy been evaluated recently? Do key members of the school community (e.g., students, teachers, administration) know the policys major components? Is the policy comprehensive? Is the policy based on the latest evidence (e.g., favouring a supportive, non-punitive approach; seeking to draw students closer, not push them away)? Has the policy been well communicated?
Drug/health education: To address the current status of drug education in each grade, the main questions to consider include: Are the intended outcomes both skills- and knowledge-based? Is drug education in some way integrated with other health issues and skills development to make it more manageable for teachers? Are the instructional methods used mainly interactive or lecture-based? Does instruction reflect progression based on development and experiences of students throughout the grades? Are teachers routinely trained on evidence-based drug education, clarifying the goals of drug education and ensuring activities are linked to those goals?
Substance use policy: School alcohol and drug policy gives direction to all substance abuse-related activity in a school and helps colour the school climate, so reviewing the policy is important. Questions to consider include: What is the status of the policy? Has it been updated lately?
Targeted activity: In any school community, a few students are likely to be at greater risk due to clustered factors in their lives (such as a challenging family background, economic circumstances, detachment from school). Some may already show signs of harmful substance involvement. Targeted efforts have the potential to interrupt a trajectory of increasing involvement. Caution is required when targeting higher-risk youth to avoid labelling them, but these efforts can be an important element of a comprehensive prevention initiative. Explore whether your school has been involved in efforts to target particular students for additional programming, services and support. What has been the effect of those efforts?
15
Once you have reviewed current and recent activities, you will be well positioned to consider next steps and build on the strengths of your efforts.
2. Learn relevant protective and risk factors

The factors linked to a young person trying or infrequently using a substance can differ from those that are linked to harmful use by some students. All young people can be seen as being at risk to some extent by virtue of the range of influences that everyone is exposed to in some measure (e.g., media, community drinking patterns). These personal, interpersonal and environmental factors can differ from those linked to persistent and heavy use of substances, which can lead to a range of substance use-related harms. During the course of a young persons development, various factors interact to determine whether a student will use psychoactive substances and whether use may become problematic. The terms protective factors and risk factors are often used to identify aspects of a person and their environment that make the development of a given problem less likely (i.e., protective) or more likely (i.e., risk). Some factors are very close or specific to a particular behaviour (for example, expectations about the rewards and risks associated with cannabis use), whereas other factors are more broad or general. A general factor such as family stability can lead to problems in any of several areas of a childs life (e.g., academic failure, bullying, and substance abuse). Through the school years early family factors (e.g., prenatal alcohol exposure, lack of parent attachment, nutritional deficiency) interact with a childs academic and social experiences and, for some, lead to later problems. However, these years also present opportunities to build protective factors in the childs life. Several factors have a general protective effect for students (i.e., they prevent substance abuse and other problems while promoting positive development): strong bonds with at least one adult (e.g., family member, teacher, other adult); clearly stated expectations for their behaviour by parents, teachers and community leaders;
opportunities for involvement and responsibility, being able to make a real contribution and feeling valued for it; appropriate life skills, such as the ability to think things through, to solve problems and to get along with other people; and being recognized and rewarded for progress in these and related areas.
While a review of factors affecting students is valuable, there is some indication that most young people who engage in binge drinking and tobacco use have only average levels of social and developmental risk factors. Their substance use may be best understood as arising from various social influences to which all young people are exposed and as risky expression of normal adolescent development. Nevertheless, these students place themselves and others at risk for a range of harms, including arguments, fights, car crashes, injuries and legal problems. Those with a high number of risk factors are likely to engage in more frequent binge drinking and illegal drug use, and experience various harms.34 Some have observed that many children are not particularly burdened by risk factors and dont experience significant problems but are still not fully prepared for adult life (that is, they may be coping but not thriving). In this sense, all young people benefit from family, school and community efforts to build protective factors into their lives.35 36
3. Determine local substance use patterns and harms

You can safely assume substance use occurs among the students in your school, but it is important to be as clear as possible on what forms it takes (i.e., nature and extent of use). Information of interest includes: the proportion of students not using any substances at different ages; age of first use of different substances; gender differences; age of peak use of particular substances; particular populations at greater risk; hazardous practices; and kinds of harms reported. While it may be difficult to fully appreciate the implications of these data initially, understanding increases with action on an initiative.
To be most effective, school substance abuse prevention initiatives need to match their goals, activities and messages to the local situation. For instance, if a significant portion of the senior-high population is using alcohol frequently and heavily, an initiative that aims to reduce hazardous use of alcohol and resulting harms while supporting students who choose not to use alcohol would make sense.
Bringing several sources of information together will help build a picture that can serve as the basis for planning.
being supported. In canvassing students, be aware that students may unintentionally exaggerate the extent of use among their peers. Therefore, having students confidentially report on their own use may be a more accurate approach. Media reports can spark interest in an issue and provide useful information, but they may misrepresent the actual situation by, for example, giving attention to emerging drugs while overlooking ongoing concerns with the use of alcohol.
As an education or health professional, you have some indication of the nature and extent of the issue through the course of your work (alcohol/ drug use policy infractions, etc.). Reliable information might also be obtained from police, public health officials, treatment specialists and local hospital emergency personnel. Any one of these sources provides only a piece of the puzzle; it is most helpful to collect and integrate information from several sources. Many provinces conduct student drug use surveys at regular intervals, and in some cases information is broken down by regions.iii Some First Nations communities use structured narratives or storytelling to develop a picture of what is occurring (health promoters are learning from this and also using this method). A critical source of information is the students themselves, or their representatives. Holding student meetings or forums or administering a survey with support from local public health officials will allow you to mine this information. A substance abuse prevention initiative that engages students sends the message that their perspectives and involvement are central, which greatly increases the likelihood of efforts
iii
None of these sources of information alone provides a full picture, but bringing several sources of information together will help build a picture that can serve as the basis for planning. Ongoing review of substance use among the student population will help you evaluate your initiative and lead to adjustment of aims and activities.
Seen from a developmental perspective, substance use satisfies a number of tasks of normal adolescent development.
4. Clarify perceptions and expectations
Its important to understand that views on substance abuse and how best to deal with it may differ widely between various groups connected to a school. What adults consider deviant behaviour may be viewed quite differently by adolescents. For example, whereas adults tend to underestimate negative behaviour to put themselves in a good light, youth often overestimate negative behaviour for the same reason. This difference in outlook is due partly to normal adolescent development, during which youth experiment with their lives in different ways and, at times, distance themselves from adult points of view. Seen from a developmental perspective,
Because these surveys do not include students absent from school for various reasons (ill health, suspension, truancy, etc.) on the day the survey is administered, and these youth are generally at higher risk for substance abuse, surveys may underrepresent the extent of substance use and harms.
17
substance use satisfies a number of tasks of normal development such as risk-taking, showing independence, testing values distinct from parental and societal values, finding a sense of belonging with a peer group, seeking novel and exciting experiences, and satisfying curiosity. Students are also influenced strongly by their perception of how common or normative substance use is. For example, if ones friends smoke, drink or use other substancesor if there is a sense that others in their networks doa young person is more likely to do so. Some may use substances as consumer items, along with clothes and music, to establish an identity or image for themselves. It is important to remember that youth are not a homogenous group, and perspectives will vary between sub-groups and with age. While working from these student perceptions, initiatives also need to account for parent and teacher viewpoints on what might work best. Teachers comfort with the topic and what they see as workload implications of a new initiative will influence their outlook. Student substance use issues can be sensitive for parents and other members of the community.37 To ensure strong support for your prevention initiative, take time to obtain these perspectives and to explain yours. The process of promoting student health and preventing problems means working through all points of view, and arriving at a plan that everyone can support. While the issues may require ongoing dialogue, it is important not to allow debate to unduly delay an initiative. Most find that between extreme laissez-faire and absolute drug-free perspectives is a balanced view of substance use in society and what schools and communities can realistically achieve to promote student health and academic success. The most promising route is to view substance abuse prevention within a broader health-promoting school approach. A longterm view of change is important with this approach, but there are small changes you can watch for along the way as you monitor the prevention initiative.
5. Assess resources and capacity to act

Its most helpful to view the school as a community or system with different elements that work best when coordinated and mutually reinforcing (as is presented in a health-promoting school approach). This broad health-promoting approach requires an individual or team to take on coordination responsibilities, and the resources invested have potentially broad payoffs: promoting overall health and learning while minimizing various risk behaviours, such as substance abuse. Regardless of the context, at this stage it is important to consider school goals, level of readiness, how well a new initiative will fit into existing frameworks in the school, personnel workload, roles, costs, and training and time requirements for implementation. If not adequately addressed in the early stages, these issues can become barriers both to adopting and maintaining the effort. Schools well positioned to take on a new substance abuse prevention initiative have a number of qualities. Please note, the list that follows presents ideal conditions; schools should proceed even if all qualities are not present. Ideally, schools:38 have a good sense of the specific need; have firm leadership or active support from school and board administration; have a broad framework (e.g., health-promoting school) in place within which substance abuse prevention can fit; have established broad acceptance of the need and avoid making top-down decisions; have a process for planning and preparing to implement new programs; have formal and informal mechanisms for coordination and cooperation; and are respectful of demands on teachers and provide appropriate training and support.
Leadership at the board and school levels is key to ensuring initial readiness and longer-term implementation. Informal leaders and champions in the community can be helpful in securing funds and overcoming barriers. However, energy and momentum for an initiative will ultimately hinge on sincere efforts to draw input from teachers and to meaningfully involve students. Initiatives are best organized by a school team (rather than an individual), ideally within a healthpromoting schools framework. It may seem difficult to assemble all the resources to fully implement a broad initiative in one step; however, if a school works within a health-promoting schools approach, it may be necessary only to strengthen specific prevention elements within this framework. Also, phasing in elements over a period of time may be more feasible, for example, by addressing the following in sequence: 1. Attend to the school culture through youth and parent engagement and other activities. 2. Introduce or refresh staff development and classroom instruction. 3. Establish a process/services to help those with severe problems to access more intensive clinical interventions. 4. Consider the merits and drawbacks of a targeted effort to identify and support higher-risk students (unless carefully implemented, targeting students can result in labelling and associated stigma (see Standard 14 ).
Schools well positioned to take on a new initiative have established broad acceptance of the need and avoid making top-down decisions.
19
B. PREPARE A CLEAR AND REALIsTIC PLAN 6. Ensure goals address relevant factors and priority harms
Whether an initiative is a stand-alone effort or imbedded in a health-promoting school framework, a school must be clear on what it wishes to accomplish in terms of substance abuse. This should be captured in a goal statement that describes the overall change the initiative aims to address. Objectives should be based on factors you have determined will have an effect on the goal (as identified in Standards 1 to 5). The team will then need to identify the actions or steps to be taken to reach each objective. Sound logic should connect all the elements of your plan: the resources available should be sufficient to undertake the activities in your plan; the team should, in turn, be confident that the activities planned will achieve the objectives identified; and finally, the initiatives objectives, if achieved, should be sufficient to accomplish the overall goal of the initiative. Objectives should be measurable; this will permit the team to evaluate whether the initiative achieves what it set out to do.
participants involved, and significant issues that have arisen. This information can be gathered by having team members observe activities and complete a short form after each, or by holding regular meetings to check on progress. The information gathered through monitoring will point to adjustments that may need to be made during the course of the initiative, and will position your team to conduct process and outcome evaluations when it comes time to evaluate and account for costs (see Standards 16 to 18). Keeping in mind the discussion on protective and risk factors that distinguished between personal, interpersonal and environmental factors (in Standard 2), school teams should aim to address factors over which the school has some control that have been shown by research to be linked to student substance abuse. Goals will vary with each school, its circumstances and grade levels, but a general outline of goals that are developmentally appropriate and generally fit substance use patterns of Canadian students may be summarized as follows: Schools with grade 1 to 3 students have a definite role to play in preventing later substance abuse. The most effective preventative goal for this level is to strengthen childrens attachments to family and school by building the capacity of all parents and teachers to manage behaviour and communicate effectively.39 Substance-specific goals focus on safety concerns and sensible use of, and alternatives to, medications (e.g., headache pills, pain relievers) and other potentially hazardous household products, while drug issues are best placed within much broader questions such as, How do I make decisions about my health? An exception to this is in communities where inhalant use occurs. In these communities, age of first use may occur during these years, so an inhalant use initiative should begin in the 6- to 9-year-old (Grades 13) range. Because of the potential immediate and long-term harms, goals need to focus on preventing use of inhalants through more intensive educational
RESOURCES ACTIVITIES OBJECTIVES GOALS

When organizing a plan this way and listing its elements under these headings, a logic model is created. The logic model is a helpful tool to think about the initiative and to ensure that elements of the plan make sense. When more specific tasks, timelines and responsibilities for each activity are added to a logic model, a work plan takes shape. The logic model and work plan should become the primary references for your team; these items will also serve as the basis for evaluating and communicating about the initiative. To be certain the initiative is unfolding as planned, it is important that the team monitor it on an ongoing basis. Monitoring is a systematic process of collecting and documenting basic information such as human and financial resources spent, activities that have taken place, number of
programming. Counselling is justified for those students who are using or are at risk of using inhalants. In schools with Grade 6, 7 and 8 students, a legitimate goal is to prevent or delay first use of alcohol, cannabis and tobacco. Generally, the first substances used are alcohol, cannabis and tobacco, and for many youth, this occurs between ages 12 and 15. Consequently, prevention activity aiming to prevent or delay onset of use of these substances should begin in late elementary school, possibly with a larger effort to support students in their transition into middle school or junior high. The percentage of students who, in some way, use one or more substances increases significantly through middle school into early high school. Much of this use arises from normal developmental changes (e.g., curiosity, exploring values distinct from adults, etc.) and changes in school, friends, expectations of benefits of substance use, academic pressures, and their environment (e.g., greater accessibility of various substances). Many students in Canada use alcohol, and to a lesser extent cannabis, in hazardous ways, beginning at around Grade 9 or 10 and continuing through high school. At the same time, a significant minority choose not to use alcohol or any other substance during these years. Ultimately, extremely few Canadians live without use of mood-altering substances, whether caffeine, alcohol, pharmaceutical products or illegal substances. Appropriate goals would be to: (a) foster insights and capacities to generally manage use, risks and harms of mood-altering substances now and in the future, (b) support students choosing not to use any substance, and (c) prevent or reduce harmful
consequences linked to alcohol or other substance use among those who use substances hazardously, by: preventing or minimizing the extent of hazardous use (e.g., reducing the frequency of use, amount used, use of more than one substance at a time, use in association with driving, unintended sexual activity, school work or sports/physical activities); and preventing or minimizing the severity of harmful consequences (e.g., arguments, fighting, vandalism, car crashes, pregnancy, overdoses, dependencies). How to best achieve these goals? This question is more fully addressed in the Standards phase D: Implement a comprehensive initiative, but to summarize briefly here, the approach is multifaceted and may include (but is not limited to): building the capacity of the school and parents to support healthy decisions through youth engagement activities; giving ongoing attention to educating staff and parents; supporting connections to home; fostering adult allies; promoting community service learning; establishing supportive services; and helping students construct relevant knowledge, skills and attitudes through classroom instruction (together summarized in a school policy). Initiatives, whenever possible, should be pilot-tested to ensure the plan will work and to make best use of resources over the longer term.
The percentage of students who, in some way, use one or more substances increases significantly through middle school into early high school.
21
7. Engage students in design of the initiative

School teams and others who plan prevention initiatives ought to see students as partners. This can be challenging for staff because it involves relinquishing some of the power in the relationship and trusting that students will manage new responsibilities well. In important ways, this process and relationship is as important as the content of the initiative itself. The process of involving students in this way has been referred to as engagement, which has been defined as meaningful participation and sustained involvement of a young person in an activity with a focus outside of him or herself, instilling a sense of active citizenship and social responsibility.40 Students are more likely to be engaged if: they feel respected, valued, trusted, appreciated, safe and comfortable; they are given the chance to be involved, make decisions, assume leadership and see their ideas acted upon; there is an enjoyable, social aspect to their involvement; and they see change and progress taking place.
A challenge for school teams is to extend participation to all studentsparticularly those who feel excluded or marginalized.
learned through supportive experience. Supportive involvement of staff means facilitating and supervising activity and, as needed, connecting students with other resources. An important aspect of facilitation is to ensure logical progression in the responsibilities that students are provided according to age and developmental ability (sometimes referred to as scaffolding).
Youth who are involved in gathering data, defining the issues or problems, program planning, modifications and evaluation are much more likely to remain engaged, thereby increasing the possibility of the initiative having the intended effect.42 They are also more likely to be open to accepting new perspectives and motivated to actively develop new skills. In the classroom, this may mean having input into drug/health education lessons by contributing to decisions on what issues to address. In every school the level of engagement among students varies widely; typically some are highly engaged while some are quite disengaged. A challenge for school teams is to extend participation to all studentsparticularly those who feel excluded or marginalized (e.g., new Canadians, GLBT students, students with mental health issues).
Youth engagement clearly supports school health-promotion aims, which have been defined by the World Health Organization as enabling people to assume greater control over, and to improve, their health.41 So, while the outcome of improving health in relation to substance use issues should be a focus, the processregardless of the outcomecan be a powerful health-promoting experience in building personal and group capacity for change. The experience of assuming greater control over ones own health and supporting others in doing so is an expression of active citizenshipa core function of schools best
8. Determine areas of leadership, cooperation and support

While determining areas of cooperation within the school community is a priority, cooperation beyond the school further strengthens the potential of most initiatives. Absolutely key to implementation is active support from school administration. If not fully present, this support may be groomed by demonstrating sound planning, implementation and evaluation of a limited, do-able initiative. Positioning the initiative to support the schools core mission is crucial; also helpful in creating a rationale will be the data collected on the nature and extent of student substance abuse and contributing protective and risk factors (see Standard 2).
Because substance abuse is one of many issues facing schools, a viable first step is to explore the feasibility of infusing the substance abuse prevention initiative into a larger framework or structure that will be more sustainable over the long term. Most schools have school-wide teams dealing with school management, student welfare or discipline issues. Is there room for a school health promotion team in the existing school make-up? A school health promotion team, employing a system lens, seeks to promote the health of all students and staff, defines the schools health issues, and explores schoolwide processes and structures that lead to improvements in the longer term. The assumption is that promoting student and staff health contributes to student learning. It is entirely possible to shift the lens of an existing school committee to ensure it assumes a health promotion perspective over time. Through one means or another, it makes most sense in terms of efficiency and sustainability for a substance abuse prevention initiative to tap into a broader committee structure. If a health-promoting school team doesnt exist, a substance abuse prevention initiative could serve as the impetus toward its creation. A team with health-promoting aims should have representative membership from the whole school community, including the principal or assistant principal and depending upon the school, people such as school counsellor(s), curriculum leader, youth and family worker, addiction prevention worker, interested teacher(s), nurse, school liaison officer (police), student representative(s), parent representative(s), and community health promotion worker. The role of the health promotion worker or similar position can take different forms, but because this individual is positioned outside the school, this perspective can be helpful, possibly playing the role of a critical friend (providing expertise, motivation, and links to external resources).43 School-community substance abuse prevention initiatives that bring together several elements (e.g., parent engagement, youth-led school and out-of-school activities and school instruction) have been found to be effective.44 45 Multicomponent approaches are in a position to address a
greater range of factors than single-component initiative; multi-component approaches typically attempt not only to influence the individual but also to engage community members and institutions in addressing the environmental and social factors that influence a particular substance use problem. Well coordinated school-community programs are complex undertakings that require long-term commitment, reasonable resources and some measure of public and political support. It takes time to build consensus on a plan; to increase cooperation, it can be helpful to package the initiative in a way that will particularly appeal to each sector. For example, underage alcohol use can be presented as a public health issue to local health workers, a family issue when talking to parents, a business issue for local stores and shops, a crime issue when talking with police and other enforcement agencies, a productivity issue for employers, and a budget issue for city leaders.46
23
C. BUILD CAPACITY AND sUsTAINABILITY 9. Conduct ongoing professional development and support
Consistent with the position that substance abuse prevention activity is best implemented within a health-promoting school framework, these Canadian Standards see professional development and support for prevention as best viewed within a larger effort to build capacity for health promotion. Building capacity for health promotion in a school focuses on systemic rather than individual change and requires the following elements: leadership and management structures that actively support a health-promoting school approach; a school team with health-promoting responsibilities and ability to access community resources; sufficient staffing resources to foster coordination and cooperation; policies and procedures with broad support; and staff professional development.47 48 Specifically in terms of substance abuse prevention, adequate ongoing training and education of all staffespecially those involved with the initiative or with a broader teamwill ensure that expertise lies within the organization (as opposed to with an external sponsor of the program). Most initiatives will likely have training implications for school staff, for example: Whole-school approaches: Training and orientation for all staff is an important consideration in the implementation of school climate or whole-school health promotion initiatives. Approaches such as these involving systemic changes take time and resources but the potential benefits are broad, longterm and closely aligned with the core mission of schools.49 Because whole-school approaches emphasize democratic processes and participation, professional development needs to reflect these same values by providing teachers full opportunity to derive meaning from the initiative and to take ownership. Consequently, the aim of professional development
for a whole-school initiative should involve hearing from the school team on its analysis of the nature of the issues, the contributing factors, and the teams proposal for shifting school structures and processes to promote protective factors. All staff should have the opportunity to provide suggestions that lead to confirming or revising the teams analysis and proposal. In this sense, professional development and planning take place concurrently. Policy: Training on the schools substance use policy is very important to ensure staff are on board and actively supportive of the norms and culture the policy aims to instil. Further, some aspects of a policy, such as alternatives to suspension, may require explanation to ensure understanding of the rationale and effectiveness of the approach. Instruction: The scientific literature is clear that health/drug education instruction needs to be student-centred and interactive in nature.50 51 This method is best embodied by constructivist educational philosophy that emphasizes active construction of knowledge by the student, with the teacher helping students see meaning and relevance in their work.52 Some teachers may receive training in constructivistoriented, student-centred learning in university preparation courses; however, the available evidence suggests that isnt necessarily the case. Training needs to offer a clear rationale for this method, provide demonstration of the interactive teaching techniques, and give ample opportunity to practice these skills. Inclass performance feedback has also been shown to be helpful in shifting teacher practices in this area. Training at the middle-school or high-school level needs to address how teachers can confidently approach sensitive topics such as student binge drinking. Acknowledging and working from the reality of widespread student alcohol use (much of it hazardous), an illegal activity for students, often creates an enormous dilemma for a school. Not addressing the issue effectively may result
in avoidable injury or death among students. Evidence suggests that instruction that aims to reduce hazardous drinking patterns and harms that can arise from these patterns can be effective.53 An alternative to having teachers address sensitive substance-related topics is to invite a local alcohol and drug prevention worker or counsellor to cover these specific topics within the context of curriculum requirements, leaving the teacher to focus more on generic life skills (e.g., assertiveness, decision-making, etc.). Regardless of the approach taken, these topics need to be addressed and all stakeholders should be comfortable with the approach taken. Parent and community education and an open, collaborative approach to arrive at clear instructional aims and elements will help to quell fears.54 Because of the need to train new staff, to give refresher training to current staff and to train for program modifications, training should occur on a regular basis. A thorough approach to shifting staff practices would see training as important but not necessarily sufficient. Aside from the school leadership and management factors mentioned earlier, a host of other factors can affect uptake of new initiatives or practices (such as a teachers sense of the feasibility, acceptability, and complexity of new practices, or sense of self-efficacy, and personal wellbeing/burnout). An approach to promoting school health that doesnt account for and include measures to promote teacher health will have muted effects. Teachers and other staff cannot be expected to be enthusiastic about student health promotion if they dont feel their own health is being promoted. Beyond professional development, support for teachers can take various forms, including feeling strongly valued, receiving positive and helpful appraisal, having a voice in school management and organization, and seeing a
clear route to seeking early assistance for their own emerging health issues.55 56
10. Address sustainability of the initiative

Schools are typically so preoccupied with ongoing demands that social and health programs such as substance abuse prevention are often seen as outside a schools core business and dealt with off the corner of the desk.57 A new prevention program may not be greeted enthusiastically by educators, and even when there is early commitment, quality delivery over the longer term is difficult to sustain. Substance abuse prevention initiatives are most easily sustained over the longer term within a broader healthpromoting school approach. In turn, the sustainability of a broader health promotion approach hinges on the ability to anchor it in the core mission of the school.58 59 Rather than an add-on, a health-promoting school initiative is about refocusing, refreshing and coordinating existing actions to improve learning and health outcomes. The reality is that the majority of students who end up having academic difficulties often experience a range of social and health challenges (e.g., violence, substance use issues, frequent school changes, and the numerous challenges confronting recent immigrants and families living in poverty). These various social and health issues also represent barriers to learning and call for schools, families and communities to work together through a comprehensive approach.60 Those in greatest need will benefit most, but ultimately, all students and staff benefit from a whole-school approach to health promotion. Because sustainability in this sense means shifting school practices through a comprehensive approach, the first step in developing a sustained approach is to gain their active
An approach to promoting school health that doesnt account for and include measures to promote teacher health will have muted effects.
25
support of school administration by building and presenting a strong argument for this approach. Other actions to promote sustainability include: bring together best possible evidence concerning substance abuse/health issues, and link these with student academic issues; educate staff and parents with accurate data on issues, and actively communicate plans; prepare a formal work plan, timetable and budget that include defined responsibilities and commitments or prospects for long-term funding;
enforcement, Aboriginal, crime prevention, probation/justice, youth, and faith groups). Within a comprehensive approach, a role for drug/health education instruction remains. Here, too, there is a question of sustainability. It is now widely accepted that teachers find health education expectations to be unmanageable (in terms of the number of learning objectives, health issues, life skills and hot topics to be covered). When taught in sequence, each of the various health issuessubstance abuse includedtend to receive insufficient curriculum time and are too often taught in a teacher-centred (rather than student-centred) format, which is more efficient but ineffective. Because each of the health issues in their turn seek to build the same life skills (e.g., self-management, decision-making/critical thinking, and interpersonal skills) as protective factors, it makes more sense to abandon a sequential approach and instead integrate priority health issues into skills development exercises in a developmentally appropriate manner.62 Student substance use problems inevitably arise, as do questions of how schools address these problems in a sustainable manner. Dealing with substance use problems on a case-by-case basis is inefficient and less effective. Planned action embodied in school policy may take more time to organize at the outset but will result in avoidance of some problems altogether and others being handled effectively and consistently. More generally, every school and community needs to work against cycles of panic and indifference that too often characterize our reactions to drug issues. Initial public response to a perceived crisis tends to be strong but shortlived. In order to maintain support for an initiative and for prevention efforts generally over the long term, communities need to understand that substance use problems are not a one-time crisis, but rather an intrinsic part of our schools and communities that need managing.
The reality is that the majority of students who end up having academic difficulties often experience a range of social and health challenges.
work toward having position descriptions that include prevention functions or having personnel assigned to specific prevention tasks; promote a long-term view, help others understand that these initiatives need to become interwoven into school processes, and identify interim markers of success associated with these processes (e.g., level of student-teacher trust) to guide schools;61 while promoting a long-term view, be open to immediate changes observed in students and the school environment, and document and publicize these changes; embed prevention or health-promoting values (e.g., promoting security, communication, and positive regard) into key school policy documents; roll out multi-component initiatives in a manageable sequence to minimize strain on resources and to maintain interest; and broaden partnerships with community groups (e.g., addiction, mental health, health, multicultural,
11. Connect with parents and community initiatives

Because many of the factors affecting the health of students and their decisions on substance use arise from factors outside school boundaries (e.g., family cohesion, community norms, leisure options), school initiatives need to connect and integrate with community efforts. Community connections can have any number of interests (from youth development to treatment) and take many forms (from informal to more formal arrangements) but they generally share a recognition that single issue/single intervention efforts are less likely to succeed and tend to fragment precious resources. Schools and communities are finding that initiatives that aim to broadly promote youth development or assets are easy to translate into different sectors of the community (e.g., schools, outof-school programs, sports leagues, parent training).
school-linked approaches is appealing and although they are challenging to evaluate, research findings support their use. School-linked initiatives differ in the degree of system change required and may be seen as forming a continuum from informal cooperative arrangements to coordination, partnerships, collaborations, and ultimately, integrated services. As would be expected, most school-linked initiatives begin with informal relationships and efforts to coordinate services. They may have any number of shared aims that in some way address substance abuse concerns, for example: enhance life in school and community, such as programs to develop youth assets, use of volunteer and peer supports, and building neighbourhood coalitions; expand after-school academic, recreation, and enrichment activities, such as tutoring, youth sports and clubs, art, music, museum programs; reduce anti-social behaviour (preventing substance abuse and truancy, providing conflict mediation and reducing violence); enhance transitions to work/career/post-secondary education; improve access to health services (including substance abuse programs) and access to social service programs, such as foster care, child care; and build systems of care, such as case management and specialized assistance.
When a school operates as a community of teachers, school administrators, parents and others who are in touch with each other and build channels of communication and cooperation, it can look forward to positive outcomes in a number of areas of students lives.
Of course, resources are required to explore and organize cooperative efforts, but there ought to be opportunities to share and ultimately save resources through a cooperative approach. These initiatives are sometimes referred to as school-linked and are defined as the coordinated linking of school and community resources to support the needs of school-aged children and their families.63 The logic behind
Whether coordination of these initiatives lies with an individual or a team, it is a crucial function. Building relationships and processes for cooperation adds complexity to an initiative and requires dedicated staff time. Parents are key influencers; factors affecting family health (e.g., family cohesiveness, stability, sense of belonging, communication styles) have a very significant bearing on child and youth health. Consequently, parents need to be
27
engaged as fully as possible in any substance abuse prevention or health promotion initiative. A school that gives concerted attention to engaging and supporting parents (e.g., through evidence-based family training), particularly in the early school years, can confer important protection to children that can snowball and provide ongoing benefits in a number of areas of a students life. When a school operates as a community of teachers, school administrators, parents and others who are in touch with each other and build channels of communication and cooperation, it can look forward to positive outcomes in a number of areas of students lives.
D. IMPLEMENT A COMPREhENsIVE INITIATIVE 12. Cultivate a positive health-promoting school climate for all
It can be difficult to define in simple terms, but school climate refers to the quality and character of the school experience for those learning, working, and playing within it. It reflects the schools norms, goals, values, interpersonal relationships, teaching, learning and leadership practices, and organizational structures. While complex and difficult to define, upon visiting a school it doesnt take long to distinguish between an open school climate in which principal and teacher behaviour is supportive, genuine, and engaged, and a closed climate in which staff are disengaged and energy is low. A fundamental aspect of school climate is relationalthat is, the extent to which people feel connected with one another and with the learning mission.64
A sense of belongingin addition to positive relationships, both students and staff experience school as meaningful, productive, and relevant; Participationactive student and staff participation and democratic processes in decision making are emphasized, opportunities for leadership and participation (e.g., service learning) are actively made available to all students; Positive orientationpositive approaches are emphasized, focusing on strengths rather than deficits; High expectationsteachers, students and parents expect success in both academic and behavioural endeavours and provide the necessary supports to achieve these expectations; Social and emotional skillsdeliberate efforts are made to reinforce use of life skills taught in classroom instruction; Parent and community involvementfamily and community members are viewed as valuable resources and their active involvement in the schools mission is strongly encouraged; Fairness and clarity of rulesstudents perceive rules as being clear, fair and not overly punitive; and School safetystudents, teachers and families perceive the school as safe.
School climate initiatives need to draw in students and families who do not feel engaged or connected with school.
Various frameworks for viewing school climate (e.g., school connectedness, school bonding, school engagement, school culture, school ethos, and social inclusion) have been studied and found to have an impact on academic performance, well-being and risk behaviours, particularly substance abuse.65 66 67 Overall, to address school climate, schools should consider:68 69 A focus on positive relationshipsintentional efforts are made to build and maintain caring and supportive relationships among students, teachers and other school staff members and families;
School personnel, whether aware of it or not, are school climate leaders; school administration in particular should set the tone. Administration will determine how structures, policies and processes are developed. Through hiring choices, modelling and training, administration can influence the nature of the teacher-student relationship toward high expectations, respect, and task-focused learning (rather than an imbalanced preoccupation with a results focus). 70 71 Students, parents and community leaders naturally follow the lead of school administration, but a positive school climate needs to be actively pursued by all members of the
29
school community (students, parents and school personnel groups), with support from the community at large. Because each individuals experience of the school climate will be personal and cannot be assumed, it is important to precede efforts in this area by assessing perceptions of school climate among students, teachers and parents. Upon clarifying needs and areas of attention, efforts to strengthen school climate are best guided by an overarching set of principles (for example, drawn from a health-promoting schools philosophy and framework) to organize and guide decision-making on strategies. These principles need to become infused into the fabric of whole-school initiatives (e.g., include them in the schools mission statement, policies, procedures), and ultimately into the everyday life of the school (e.g., student government, class meetings, sports, assemblies). This allows various activities and initiatives to reinforce and complement each another.72 Full consensus on climate needs among all members of the school community (students, teachers and parents) is not likely to be reached. School climate initiatives need to give priority to drawing in students and families who do not feel engaged or connected with school. A good starting point is to work back to general principles that everyone can agree on; working from data on perceived needs and gaps provides a strong base and rationale for action. Comprehensive actions that have broad support can then be identified avoid short-term, fragmented initiatives and focusing on single elements of school climate (e.g., school safety, rules and expectations). School climate initiatives should also address ongoing orientation and training. Topics could include teacher-tostudent relations, student-to-student relations, positive techniques, fairness and clarity of rules, and school safety, but particular attention should be paid to issues identified in the school assessment. As with all health-promoting schools-related orientation and training, the planning and delivery of these sessions should be fully participatory, and administration-, teacher-, or student-led (as opposed to being led by an expert).
A challenge with all such initiatives is to maintain momentum over the long term. however, if designed to build capacity (rather than build dependence on external resource persons), these efforts can become self-sustaining. To keep the initiative alive and on track, check back with members of the school community on a regular basis to assess perceived changes in the climate to note and celebrate successes, and to revisit and adjust aims as needed.
13. Deliver developmentally appropriate classroom instruction at all levels

The ability of universal drug/health education instruction to bring about healthier student behaviours on its own is limited.73 The aim of reducing various health risk behaviours (e.g., reducing the prevalence of binge drinking; unsafe sex) is most feasible for a comprehensive health-promoting schools approach. The most realistic goal of drug/health education classroom instruction is to increase knowledge and skills and to shift attitudes. Seen this way, the health education aims of classroom instruction are distinct from, but supportive of, health promotion aims for the whole school and community. Fundamental impediments to achieving these aims do exist, including: teachers often indicate there are too many learning objectives in a health curriculum; insufficient time in the schedule to permit the various health issue areas (e.g., substance abuse, nutrition, sexual health, bullying) to be implemented as designed when delivered in sequence; evidence-based practice for these various issue areas tend to focus on building many of the same skills (e.g., self awareness, decision making, critical thinking, communication, and assertiveness skills), which leads to redundancy; and young people do not favour separating health topics, such as drugs, smoking and sexual health.74
Consequently, to engage teachers and students fully with the health education curriculum, all health issue areas including substance abuseshould be reconsidered to operate from the four principles of integration, progression, student-centred interactivity, and engaging in and effectively managing sensitive topics. Integration: Health education should focus on the whole healthy child. In a way that is relevant and developmentally appropriate, functional information on priority health issues (such as substance abuse, physical activity, nutrition, sexual health, bullying and violence, and mental health) should be integrated into instruction on key life skillsfor example, organized as (a) coping and self management skills, (b) decision-making and critical thinking skills, and (c) communication and interpersonal skills.75 Integration of health issues can occur through a transferoriented approach in which students are stimulated to apply the knowledge, attitudes and skills they have learned with one health issue (e.g., refusal skills for smoking) to other issues (e.g., refusing unsafe sex or alcohol).76 The teaching content focuses on building bridges between various issues and behaviours by identifying general principles and considering whether and how they can be applied to other areas.
Progression: From the primary grades through to Grade 12, drug/health classroom instruction should be organized to cover age-appropriate priority health issues and key life skills. Recommended is a spiralling approach that avoids repetition and progresses to mastering key life skills in relation to priority health issues. Overall, drug/health instruction should show progression through the grades in the following ways:77 student knowledge becomes more detailed relevant vocabulary widens conceptual understanding deepens ability to see connections and to generalize develops skills reflect increasing complexity new knowledge, skills, and attitudes not only add to but also enrich previous learning students views of supporting others with respect to substance use widens appreciation of moral and ethical issues develops
Life skills instruction should also reflect systematic progression within and across grades as follows:78 1. Defining and promoting specific skills: defining the skillswhat skills are most relevant to influencing the targeted behaviour? What will the student be able to do if the skill-building exercises are successful? generating positive and negative examples of how the skills might be applied; encouraging verbal rehearsal and action; and correcting misperceptions about what the skill is and how to do it.
SKills to GeNeral PriNciPles OF reFusiNg cigarette

reFuse a
APPlYiNg tHese PriNciPles to reFusiNg alcoHol or uNsaFe seX
Integration can also refer to the integration of substance use topics into other subject areas. This should be encouraged by orienting all staff to understand and reinforce key substance use/health promotion messages. Integration of substance abuse topics in this manner is particularly critical at the highschool level. Hazardous alcohol use is sufficiently common in Canadian high schools to warrant universal attention through classroom instruction, but since most high-school students do not take a health-related course, opportunities must be sought through other courses.
31
2. Promoting skill acquisition and performance: providing opportunities to observe the skill being applied effectively; providing opportunities for practise with coaching and feedback; evaluating performance; and providing feedback and recommendations for corrective actions.
3. Fostering skill maintenance/generalization: providing opportunities for personal practice; fostering self-evaluation adjustment; and and skill
exploring ways to use or adapt skills with other issues, new situations.
If the health-promoting school encourages empowerment, participation, democracy and open communication, these principles must be reflected in classroom methods.
principles must be reflected in classroom methods. To promote interactivity, the teacher does not assume to be an expert but rather serves as guide, setting an open, nonjudgmental atmosphere, managing the process as a facilitator (rather than as a presenter), and maximizing the opportunity for peer interchange and skills practice. The teacher has an important role in correcting misperceptions that may arise and in organizing efforts to obtain or clarify information as needed.82 A constructivist-oriented drug/health education curriculum can be organized according to various frameworks, such as:83 Investigation and significance: pupils explore the relevant theme or topic and attempt to determine its significance and value to their own lives. Visions and alternatives: pupils attempt to develop their own dreams, values and visions for how they would like to change and develop the conditions within the relevant theme or topic. Action and change: pupils develop proposals for specific action that brings them closer to their own visions. They choose an action and try it in practice then compile the results, assess them and perhaps adjust the action and initiate new action.
Student-centred interactivity: The insight and skills development that is integral to drug/health education requires interactive teaching and learning approaches. Structured and unstructured task-oriented peer interaction between classmates is key to effectiveness; the opportunity to practice new skills, to test out and exchange ideas on how to handle substance use situations and to gain peer feedback about the acceptability of ideas in a safe environment are more important catalysts for change than any critical content of the program.79 This constructivist approach sees students as inherently capable of actively constructing knowledge and deriving their own insights or meaning (rather than passively receiving knowledge). A constructivist approach:80 81 promotes deeper understanding of knowledge and concepts; encourages discussion and debate to allow participants to see the world through other eyes; and calls for integration of drug/health education curriculum and instruction.
Student-centred interactive drug/health education leans heavily on small-group, peer-led formats and can, for example, include the following: discussion of scenarios and case studies brainstorming solutions to problems demonstration and guided practice
If the health-promoting school encourages empowerment, participation, democracy and open communication, these
role play; practising life skills specific to a particular context with others cooperative learning educational games and simulations storytelling debates audio and visual activities, e.g., arts, music, theatre, dance decision mapping or problem trees
14. Organize targeted activities within a comprehensive continuum

Schools often establish various extra services to respond to acute learning and health needs of students as they arise. Over time, an uneven, uncoordinated array of services and approaches can evolve. For example, there may be a rush to assessment and referral in some instances, while in others there may be a tendency to wait until a problem is impossible to ignore. Children with externalizing behaviours (e.g., noncompliant, aggressive) tend to be identified and intervened with more quickly than those who internalize (e.g., depression, anxiety). A health-promoting school approach can provide a framework or continuum to help organize and guide decision making on targeted actions for various issues including substance abuse. The continuum should have a strong universal, preventive aspect but also give guidance on early and later intervention, forming three broad elements:85 strategies/processes for promoting development and preventing problems healthy
Engage in and eectively manage sensitive topics: Most of the priority health issues (tobacco/substance abuse, nutrition/obesity, sexual health, violence, mental health) have sensitive topics associated with them (such as handling student disclosures, addressing specific detailed questions, fielding personal inquiries from students, etc.). Its important for teacher teams, schools, parent councils, and/or school boards to clarify how these topics should be managed. Teachers given no direction on how to effectively and comfortably respond to these topics are more likely to avoid them altogether, placing students and others at risk that could be avoided. Local health promotion or counselling professionals with expertise on these topics may be able to provide guidance to teachers and even deliver specific parts of the instructional content. With drug education, the central challenge lies in managing the exploration of an activity such as binge alcohol use, which is illegal, harmful and common among students in most parts of Canada from about Grade 9 onwards. Each school or board should work through this challenge, consulting widely and referring to the best available data (e.g., provincial/district student substance use survey). Since a mistake or poor choice can result in significant harm or even death, the best advice is this: as binge alcohol use or any other substance-related risk behaviour becomes normative in a specific age group, health education instruction must include exploration of ways to reduce the hazardous behaviour and harms that could arise while continuing to present non-use as a health-promoting option.84
strategies/processes for intervening early to address problems as soon after onset as is feasible strategies/processes for assisting with severe, ongoing problems
A health-promoting school framework strives to engage all students in their learning and social and emotional health. At some point, most students experience some vulnerability in their academic or social and emotional lives, particularly during transitions between elementary, middle and high school. A school milieu that is open about these challenges and provides routes for additional support is most healthpromoting. Less formal routes based on natural relationships such as an alert peer or teacher providing an attentive ear need to be encouraged and considered part of a framework. A few students may be identified as particularly vulnerable due to an accumulation of risk factors. Schools need to anticipate this and prepare informal processes for engaging these students in whole-school activities. The general aim of
33
these processes is to increase learning and social connections for all students. Beyond these whole-school efforts, schools may consider the need for early interventions for especially vulnerable students. At the elementary level, these initiatives typically aim to improve educational environments and parenting skills, reduce social exclusion and aggressive and disruptive behaviour.86 These targeted early-school efforts can have a positive snowballing effect, providing benefits on an array of later issues, including substance abuse. Central to the effectiveness of these initiatives is fostering a sense of schoolparent partnership that leads parents and teachers to feeling mutually supported in their efforts.87
In all cases, but particularly at the middle- and high-school levels, targeted initiatives need to be approached with caution to avoid labelling and ghettoizing a student.
by virtue of having an accumulation of risk factors. Their pattern of alcohol and other drug use is typically limited to their adolescent years. Nevertheless, these students place themselves and others at risk for a range of harms including arguments, fights, car crashes, injury and legal problems, so some form of whole-school attention is warranted to shift school and community culture in relation to hazardous substance use. For other students in late middle school and high school, hazardous substance use is part of a larger pattern of deviancy that is more likely to extend into adulthood. Opportunities for assessment and clear referral routes to services in the school or community are important for students with ongoing severe academic and health issues that include substance abuse. Caution is advised in bringing higher-risk students together into new groups as this has been found to increase substance use in some cases (participants in these groups can validate and legitimize the antisocial behaviour of other group members).89 To gain maximum effectiveness and avoid fragmentation, targeted substance abuse-related processes or strategies need to be situated within a whole-school continuum that follows these principles:90 enhance regular classroom strategies to enable learning (i.e., improving instruction for students who have become disengaged from learning at school and for those with mild to moderate learning and behaviour problems); focus on root factorsavoid tendency to develop separate approaches or processes for each problem; support transitions (i.e., assisting students and families as they negotiate school and grade changes and many other transitions);
In all cases, but particularly at the middle- and high-school levels, targeted initiatives need to be approached with caution to avoid labelling or ghettoizing a student; the stigma associated with being targeted may result in the initiative having more harm than benefit. Again, cultivating a healthpromoting milieu in which students are encouraged to take control of their own health and support others in doing so can minimize this danger by encouraging self- or peer-referral to supportive services as needed. Early use (e.g., late elementary and early middle school) of alcohol, tobacco and/or cannabis is a concern because it is linked to various later problems, including dependency. Early substance use usually arises from emotional health issues stemming from earlier family and school factors that warrant attention themselves, but the substance use calls for particular attention. Canadian research with this population has found brief interventions (based on personality type) to be promising.88 Hazardous alcohol use is common in Canadian high schools, yet most students will not be exposed to course-level attention to alcohol use topics. The majority of students who use alcohol hazardously would not be viewed as at risk
increase home and school connections; avoid actions or processes that may result in students being labelled and stigmatized; respond to, and where feasible, prevent crises; increase community involvement and support (outreach to develop greater community involvement and support, including enhanced use of volunteers); facilitate student and family access to effective services; and give first preference to least restrictive, non-punitive and non-intrusive forms of intervention.
of the school. The policy should include a rationale (linking to health promotion policies or broad school aims), an indication of roles and responsibilities, a communications plan, and a schedule for regular review. The policy brings together and clarifies the schools commitments, rules, procedures and actions in relation to substance abuse, which should include the following: 1. prevention of substance use problems; 2. intervention with problems (early problems as well as dependent use); 3. schools position regarding possession, use, or distribution of alcohol, tobacco and illegal drugs; and 4. disciplinary measures for infractions. The benefits are wide-ranging. Having a clear, balanced, and well-communicated policy gives everyonestaff, students and parentsa shared reference point on expected behaviours, procedures and legal responsibilities on matters concerning substance use. Administration avoids making up rules on the fly, staff are able to speak with confidence on these matters, and students and parents have some assurance that issues will be handled in a fair and consistent manner. The content of policies is important but the way they are developed, communicated and enforced is equally so.93 A participatory approach to these processes is more timeconsuming but has a health-promoting effect by giving staff and students a sense of ownership over this part of their lives; it will lead to greater support for the policies and decisions that subsequently arise. A balanced policy seeks instructive and healthpromoting resolutions to issues, including logical consequences for infractions and minimizing out-ofschool suspensions and other punitive actions. School suspensions often lead to increased antisocial behaviour, so
Some schools may consider directing particular attention to Aboriginal students. Recommended by Aboriginal teachers and elders is a culturally competent approach wherein Aboriginal knowledge and contemporary wisdom are presented as equally integral to a students development. It is believed the internalization of cultural values can be the basis of a profound sense of belonging to the land, community and society, which can directly influence how young people will care for themselves and others.91 92
15. Prepare, implement and maintain relevant policies

What students, teachers and administrators say and do (i.e., their attitudes, behaviours and intentions) in regard to substance use and abuse come together to form a schools norms. Norms are the product of many influences including parents, the community, media and society; however, formal school policy is an important mechanism to influence school norms and culture. A health-promoting school policy establishes a healthy school setting for all who spend time there, providing a strong context for substance abuse policy.
The content of policies is important but the way they are developed, communicated and enforced is equally so.
Substance use policy is a statement of how a schools substance use-related actions contribute to the health promotion aims
35
policy should seek to help high-risk youth maintain links with school and facilitate interactions with other students whenever possible.94 A process for preparing policy should include these steps:95 1. Ensure broad representation in the development process from the school community. 2. Complete a needs and capacity assessment. 3. Clarify legal obligations. 4. Ensure that intervention procedures to support students experiencing problems are in place. 5. Agree on the content, and write the school policy. 6. Create and implement communication plan. 7. Release policy; review it on a regular basis and revise as necessary.
E. EVALUATE ThE INITIATIVE 16. Conduct a process evaluation of the initiative

Professionals continually respond to feedback and try to find time to reflect on the quality of their work and its effects. Evaluation addresses these same questions of quality and effects systematically. While it shouldnt replace professional reflection, because evaluations bring together more information and strive for objectivity, they complement reflection and are considered a central part of an initiative not an add-on. Process evaluation is concerned with how well the initiative is operating in relation to plans. Because school prevention and health promotion initiatives tend to be long-term, an evaluation that helps keep an initiative progressing as intended is important. An outcome evaluation is important in that it establishes whether an intervention has worked or not, but it doesnt provide insight into implementation issues. Without a process evaluation it would be impossible to tell, for example, whether the apparent failure of an initiative was because it was the wrong one or because it was poorly implemented, or whether it was a success in ways not anticipated. Process evaluation data is critical in understanding and interpreting much of the data collected through an outcome evaluation. Preparing a clear plan and collecting information on the implementation of the plan positions the team well to conduct a process evaluation. Because a process evaluation is concerned with the quality of implementation, it draws on information collected while monitoring implementation (as noted in Standard 6). While a process evaluation considers information collected through monitoring, it is distinct from monitoring because the focus is not to change things while they are happening but to document and understand them. Important aspects of implementation to investigate in a process evaluation are: Reachdid the initiative reach all of the target population?
Acceptabilityis the initiative acceptable to the target population? Fidelitywas the initiative implemented as planned?
Reach refers to the number of participants, or members of the school community affected by the initiative. It is helpful to discuss how reach was achieved and to identify possible explanations for problems with reaching intended numbers. Recommendations for further action may also be presented. Acceptability addresses the extent to which participants are satisfied with the initiative, asking such questions as: Do participants feel comfortable in the program? Do they feel listened to and understood? Are topics relevant and interesting? Is the pace too fast or too slow? Is it too difficult or too easy? Are staff engaged and approachable? Are leaders people participants can relate to (for example, ethnicity, age, experience)? Are the venue location and facilities suitable? Are the cost and timing of activities suitable?
Fidelity is concerned with whether all the activities of the initiative are being implemented as planned, whether any unexpected problems have arisen, and if any adjustments need to be made. Various methods can be used to obtain information for process evaluation, including surveys, interviews, focus groups, observation and document analysis.96 In addition to being well implemented, a prevention initiative must achieve what it set out to accomplish; it must achieve its goals and objectives. That is why an evaluation that looks at the impacts or outcomes of an initiative is important (see Standard 17). Resources supporting the Canadian Standards provide further guidance on evaluation.
37
17. Conduct an outcome evaluation of the initiative

While the process evaluation helps your team know whether an initiative unfolded as planned, to discover if it has achieved what was intended an outcome evaluation is required. Together, the process and outcome evaluations provide strong evidence of the nature and effectiveness of an initiative. The purpose of an outcome evaluation is to discover the extent to which an initiative met its objectives. The objectives of a school initiative should focus on the protective and risk factors the team has chosen to target in order to achieve the overall goal of an initiative. The outcome evaluation centres on the immediate (rather than long-term) effect of your initiative on these objectives. Planning for an outcome evaluation occurs alongside planning for the initiative. The key tasks in undertaking an outcome evaluation include: 1. Identify the outcome indicators to be used (planning stage) To allow the initiative to be evaluated, the team needs to identify outcome indicators for their activities when planning the initiative. Indicators specify the type of change that is expected and the percentage of people for which change is anticipated. Questions to ask are: (a) how will we know when we have reached this objective? and (b) what indicators will be appropriate to measure the degree to which the objective was met? An outcome indicator may, for example, specify an increase in knowledge and awareness of the hazards associated with binge drinking in 70% of Grade 7 and 8 students. Rather than identifying all possible outcomes, specify only priority outcomesthe ones that will tell you most about the initiatives progress.
2. Identify the information to be collected and methods of doing this (planning stage) Outcome indicators can be quantitative or qualitative: qualitative indicators assess students perceptions and experiences, while quantitative indicators measure the numbers of things that take place. Qualitative methods most frequently used for collecting outcomes information are: surveys focus groups observation interviews document review and analysis
Quantitative indicators are measured through survey instruments. A team may develop its own questionnaire specific to its intervention. Existing instruments often have the advantage of having their validity (the extent to which measures actually measure what they intend) and reliability (the extent to which the measures give consistent results) confirmed. 3. Design the evaluation to increase condence that observed eects are due to the initiative (planning stage) The best way to establish that an initiative has been effective is to design the evaluation in a way that rules out alternative explanations for any changes found in the outcome indicators. The standard evaluation design involves comparing one group of people participating in the initiative with another group that doesnt participate (i.e., comparison group). The most rigorous method is to randomly assign persons into participant and control groups. However, designing an evaluation with comparison or control groups is often not feasible for school health initiatives. In these cases, its important to use pre-program measurement to provide a baseline against which the post-program results can be compared. Without a control/comparison group or pre-post comparisons, it will be difficult to rule out other explanations for any changes that may have
occurred. Nevertheless, a case for effectiveness can still be made if processes are well documented (through a process evaluationsee Standard 16) and if appropriate indicators clearly and objectively measure achievement of the objectives. 4. Conduct the outcome evaluation Prior to conducting the outcome assessment, it is necessary to determine timelines for when data will be collected, sample sizes, and identify who will be in the sample. Beyond these questions, the team will need to give attention to the following tasks: Data collectionadminister questionnaires, conduct interviews, observe program operations or review or enter data from existing data sources. Data recordingcollate the information gained through data collection, ensuring that it is accurate; translate collected data into useable formats for analysis. Data analysisconduct statistical analyses (where relevant) or content analysis of qualitative data and prepare summary statistics, charts, tables and graphs
with the process evaluation, it can serve as the basis for adjustments and improvements to the initiative. In addition to achieving its objectives, an initiative should account for its costs and analyze them against the effects of the initiative (see Standard 18). Resources supporting the Canadian Standards provide further guidance on conducting an outcome evaluation.
18. Account for costs associated with the initiative

It is important to know what has occurred with an initiative and whether it has been effective in achieving its objectives. It is also essential to assess costs associated with an initiative against what it has achieved. An initiative may be effective but more expensive than alternatives, or cheap but not effective. In considering costs, it is necessary to decide how to define costs (i.e., what costs to include). A prevention initiative may choose to account for only the costs that schools or boards dont already cover; however, full economic accounting also calls for an estimate of the opportunity coststhe value of all goods and services that society must give up in order to have the initiative, regardless of who pays for them. The following provides a simple distinction between low, medium and high estimates to illustrate the considerations involved in defining costs for school-based prevention.98 Low estimateprogram materials + teacher training time + community hall rental for youth leadership training: based on the assumption that it is only necessary to account for costs that sponsors (e.g., school boards) dont already cover (i.e., materials, teacher training and hall rental). Medium estimatelow estimate + teacher salary while delivering program: assumes that there is an opportunity cost due to teacher time being diverted from other activities to the prevention initiative.
5. Share and use the outcome evaluation An evaluation report should be simple, brief and logically organized to make it easy to read. It can be helpful to present the information in different ways to various audiences (e.g., formal report; verbal presentation, poster, newsletter article). Reporting back to those participating in the evaluation (i.e., those who gave you outcome information and those who collected it) is important.97 Sometimes an outcome evaluation will reveal unintended outcomesthings that occurred that were not thought about in the initial planning of the initiative but that are nevertheless important. An evaluation may also show that the initiative didnt have the desired positive effect. This is important information because along
39
High estimatemedium estimate + facility costs: assumes opportunity costs to the school facilities (i.e., they could be used for some other educational purpose if they werent being used for the initiative); this permits cost-effectiveness comparisons with other drug demand reduction methods that usually include facility costs, like treatment and incarceration.
deliver drug education instruction can be better justified by delivering sessions that have broader educational value (e.g., promoting critical thinking).100 An accounting of costs will allow a team to conduct a cost analysis, investigating questions such as: Is the initiative worth doing? Do the benefits justify the costs? What is the cheapest or most efficient way to get results from the initiative? What are the cost implications of expanding or shrinking the initiative? How do the initiatives costs affect its sustainability? What are the cost implications of implementing the initiative elsewhere in the board?
Another question to consider is who bears the cost of an initiativefor example, distinguishing between those costs borne by the primary sponsor, partner agencies, and participants. 99 Direct costs to the agency delivering the initiative: includes easily determined costs such as brochures and telephone bills, but also less easily determined costs such as staff costs (as considered above) and management expenses. Direct costs to other agencies involved in the initiative: support may be given in-kind by other agenciessuch as volunteer time and donated resourcesrather than in the form of monetary resources. They may be difficult to quantify, but if they have alternative uses, these types of costs have some form of economic value. Direct costs to the individuals participating in the initiative: for example, transportation costs or other expenditures incurred by a family in order to participate. Indirect productivity costs to participants: lost productivity as a result of participating in a prevention initiative (e.g., missing weekend work to attend training).
In a full accounting of costs, program research and evaluation costs would also be included. Readiness of the school community or target population may be seen as a variableif the group to whom a program is directed is not engaged and motivated, participant recruitment will consume more effort and materials. Several months of promotion may be required to give the program visibility and to encourage participation by young people. Costs of using valuable classroom time to
3.
SECTION THREE: Workbook

10-MINUTE REFLECTION
While the Task Force recognizes that some readers will be building an initiative from scratch or planning to adopt a new program, this Reflection exercise is written for those reviewing an entire existing program. It will be helpful for any individual practitionera teacher, administrator, public health staff, nurse, or program developerbut is primarily intended for a team involving practitioners and students, counsellors, parents and community representatives. Terms used in this reflection exercise are discussed in Section 2: Canadian Standards. The Standards are grouped into five phases. Each of the following 18 reflection questions pertains to one of the Standards. Depending on your situation, certain phases or reflections may not be immediately applicable, but action on all Standards is recommended. A. Assess the situation o o Do we know the prevention activities already in place and how well they are working? Do we know the factors that strengthen our students or alternatively place some at risk for substance abuse? Have we determined student substance use patterns and harms? Have we clarified the perceptions and expectations of all concerned (students, staff, parents, other stakeholders)? Have we assessed our schools resources and capacity to act?
Its vital that school teams see substance abuse prevention as a process rather than a place to arrive at.
o o
B. Prepare a clear and realistic plan o Do our goals address relevant factors and priority harms for our students? o Have we engaged students in the planning process? o Have we identified areas of leadership, cooperation and support?
41
C. Build capacity and sustainability o o o Do we conduct professional development and support on an ongoing basis? Have we taken steps to sustain the initiative? Are we connecting with parents and community initiatives?
D. Implement a comprehensive initiative Do we take steps to cultivate a positive healthpromoting climate for all in our school? o Are we delivering developmentally appropriate classroom instruction at all levels? o Have we implemented targeted activities as needed? o Have we prepared, implemented and maintained relevant policies? o E. Evaluate the initiative o o o Are we conducting a process evaluation of our initiative? Will we measure outcomes of the initiative? Have we accounted for costs associated with our initiative?
IN-DEPTh REVIEW
The in-depth review is a self-assessment that enables you to: judge the extent to which your schools initiative meets the Canadian Standards for School-based Substance Abuse Prevention; identify the strengths of, and possible areas of improvement for, your schools efforts to address substance abuse; and ready your initiative for assessment by an expert panel. The in-depth review is best done as a group effort by an existing team or one assembled for this purpose. A group review often brings more insight and better prepares your school to plan to address the reviews findings. You may wish to set aside roughly three hours to complete the full review, or a series of half hours to discuss and respond to each of the five sections in turn. You will be asked to assess the extent to which your schools current initiatives meet the 18 Canadian Standards. Each question is preceded by a brief discussion of the rationale and evidence behind the Standard. Several detailed questions are posed to help you consider your response. For each Standard, you have the option of checking off the most appropriate response as follows:
FULLY
PARTIALLY
UNDER DEVELOPMENT
NOT DONE
You will also be asked to briefly explain what your school has done to achieve this Standard and the results of those particular efforts. For your own referenceand for any future expert panel review, should you choose to pursue that routeyou are asked to note whether there is any supporting documentation (reports, meeting minutes, etc.) for your response to each Standard. You will find a Canadian Standards Rating Sheet to score each of your responses as follows:
FULLY 3 PARTIALLY 2 UNDER DEVELOPMENT 1 NOT DONE
You can then tally the results to assess your schools overall efforts. The Canadian Standards reflect the highest standards in prevention initiatives; no school should expect to achieve consistently high scores. The point of the review is not to compare your school with others, and there is no failing grade. Rather, your totals help identify areas of activity your school can aim to strengthen. This in-depth review provides a snapshot of how well your school currently addresses substance abuse. However, its vital that school teams see substance abuse prevention as a process rather than a place to arrive at.
The point of the review is not to compare your school with others but to help you better understand your school and the quality of your current efforts.
43
1.
Have we fully accounted for the prevention activities already occurring?

FULLY
PARTIALLY
UNDER DEVELOPMENT
NOT DONE
Consider: a. Does our school have a clearly communicated and well-understood drug policy? If so, what is the goal of the policy? b. Is our school involved in efforts to improve its social and academic climates? c. Do we know the drug education content covered in each grade last year? d. Were any groups of students selected for additional prevention activity last year? Describe your eorts and results:
Supporting documentation attached o

2.
Have we learned the factors that strengthen our students or place them at risk for substance abuse?
FULLY
PARTIALLY
UNDER DEVELOPMENT
NOT DONE
Consider: a. Do we understand how our schools social and academic environment serves to protect or place our student population at risk? Do we understand the importance of students connectedness, voice and leadership, and availability of adult allies? b. Do we understand the unique risk factors experienced by some students or sub-populations due to mental health issues, gender, sexual orientation, culture and ethnicity? c. Have we considered the impact of the broad determinants of health (e.g., family income and parent educational levels, early childhood experiences) for some students in our school? Describe your eorts and results:

45
3.
Have we determined student substance use patterns and harms?

FULLY
PARTIALLY
UNDER DEVELOPMENT
NOT DONE
Consider: a. Are we clear on the extent of occasional, regular and heavy use (and age, gender differences) among our students? b. Have we determined whether there are specific substances or substance use patterns that need to be addressed through our initiative? c. Are we drawing from more than one reliable source for information on usage patterns (e.g., provincial/district student survey; emergency room and police data)? Describe your eorts and results:

4.
Did we clarify the perceptions and expectations of students, staff, parents and other stakeholders?
FULLY
PARTIALLY
UNDER DEVELOPMENT
NOT DONE
Consider: a. Do we understand students perceptions of substance use benefits and harms? b. Have we assessed teachers, parents and administrators perspectives on student substance use, and how best to respond? c. Did we make an effort to educate ourselves, parents and other stakeholders on the realities of youth drug use and effective responses? Describe your eorts and results:

47
5.
Have we assessed our schools resources and capacity to act?

FULLY
PARTIALLY
UNDER DEVELOPMENT
NOT DONE
Consider: a. Is there an existing framework (e.g., health-promoting school) within which substance abuse prevention can be addressed? b. Have efforts to date proven effective or promising? c. Have we allocated a budget and staff time? d. Is there a sense of readiness for a new or renewed initiative on the part of key personnel? e. Can we expect to receive help from community agencies to support or complement our efforts? f. Do we have a champion(s) for our initiative? Describe your eorts and results:

6.
Do our goals address relevant factors and priority harms for our students?
FULLY
PARTIALLY
UNDER DEVELOPMENT
NOT DONE
Consider: a. Have we established a clear goal(s) for substance abuse prevention that is within the schools capacity to accomplish? b. Are our goals and actions reflective of best practices in prevention, developmentally appropriate and do they fit substance use patterns of our students or community? c. Have we logically linked our goal(s), objectives and actions, and developed a logic model and work plan? d. Do our goals reflect a positive orientation, emphasizing student and school strengths rather than deficits? e. Are we working with others in the school or community to address shared protective or risk factors? Describe your eorts and results:

49
7.
Have we engaged students in the planning process?

FULLY
PARTIALLY
UNDER DEVELOPMENT
NOT DONE
Consider: a. Have we approached and recruited students for whom the initiative is intended as partners? b. Are participating staff comfortable with sharing leadership and playing a facilitative and supervisory role (rather than directing activities)? c. Does our plan reflect a logical progression (according to age and developmental ability) in the responsibilities that students assume? d. Are students involved in all aspects of planning and implementation (i.e., data gathering, defining issues or problems, program planning, evaluation and identifying modifications)? e. Do our students have the opportunity to provide leadership and give voice to their views? f. Do we extend participation to all students in school and make particular efforts to engage students who may feel excluded or marginalized? Describe your eorts and results:

8.
Have we identified areas of leadership, cooperation and support?

FULLY
PARTIALLY
UNDER DEVELOPMENT
NOT DONE
Consider: a. Have we gained the active support of school administration, counsellors, youth and family workers and other particularly relevant staff ? b. Have we explored the feasibility of infusing the substance abuse prevention initiative into a larger framework or committee structure? c. Do we have broad representation from the school community on the team (including parents)? d. Are there community initiatives that share our interests or aims? Describe your eorts and results:

51
9.
Do we conduct ongoing professional development and support?

FULLY
PARTIALLY
UNDER DEVELOPMENT
NOT DONE
Consider: a. Are teachers trained in student-centred and interactive instruction and whole-school practices as needed? b. Have high-school drug/health education teachers been coached to confidently address, directly or indirectly, sensitive topics, such as student binge drinking? c. Have local health promotion or counselling professionals been recruited to support classroom teachers on specific content issues such as binge drinking? d. Are staff training methods fully participatory in nature? e. Do staff training opportunities include opportunities for students to voice their perceptions and experiences? f. Do school structures and processes reflect democratic values? g. Are measures (i.e., policies, procedures, activities) in place to promote teacher health? Describe your eorts and results:

10.
Have we taken steps to sustain the initiative?

FULLY
PARTIALLY
UNDER DEVELOPMENT
NOT DONE
Consider: a. Have we created a strong evidence-based argument directly linking the initiative to the core mission of the school? b. Have we educated staff and parents with accurate data on the issues? c. Have we included plans or prospects for long-term funding in our work plan? d. Are we aiming to embed prevention or health-promoting values (e.g., promoting security, communication, and positive regard) into key school policy documents? e. Are we working toward position descriptions that include prevention functions? f. Are we promoting a long-term view in the school and community, working against cycles of panic and indifference? Describe your eorts and results:

53
11.
Are we coordinating with parents and community initiatives?

FULLY
PARTIALLY
UNDER DEVELOPMENT
NOT DONE
Consider: a. Have we devoted effort to exploring connections with parents, and with community initiatives? b. Have we dedicated staff time to building relationships and processes for cooperation for our initiative? c. Has our school given concerted attention to engaging parents and building channels of communication, cooperation and mutual support? Describe your eorts and results:

12.
Do we take steps to cultivate a positive health-promoting climate for all in our school?
FULLY
PARTIALLY
UNDER DEVELOPMENT
NOT DONE
Consider: a. Have we assessed our schools climate as perceived by diverse members of the school community, and made plans to check back regularly to assess perceived changes and adjust aims as needed? b. Is school administration providing leadership on the school climate initiative? c. Have we tied or infused positive school climate principles into the fabric of core school structures and activities (i.e., schools mission statement, student government, class meetings, sports, assemblies)? d. Have we given priority to drawing in students and families that do not feel engaged or connected with school? e. Have we managed to avoid short-term and fragmented initiatives, or tie them into our whole-school framework? f. Do we provide ongoing orientation and training on school climate, using participatory methods? Describe your eorts and results:

55
13.
Are we delivering developmentally appropriate classroom drug/health education instruction at all levels?
FULLY
PARTIALLY
UNDER DEVELOPMENT
NOT DONE
Consider: a. Does our classroom instruction focus on the whole healthy child by integrating, in a way that is relevant and developmentally appropriate, functional information on priority health issues with instruction on key life skills? b. Does our schools drug/health education instruction reflect a spiralling approach that avoids repetition and builds a progression in mastering key life skills in relation to priority health issues? c. Do our teachers, particularly at the middle-school level, employ methods that promote a high degree of student-tostudent interactivity and focus on development of skills and insights? d. Do we seek integration of key substance use topics into other subject areas at the high-school level to ensure all students are exposed to education on hazardous practices? e. Do our teachers directly or indirectly (i.e., by bringing in health or counselling professionals) cover sensitive topics, such as binge drinking, combining substances, unsafe sex, and violence? Describe your eorts and results:

14.
Have we implemented targeted activities as needed?

FULLY
PARTIALLY
UNDER DEVELOPMENT
NOT DONE
Consider: a. Do we situate targeted services within a larger continuum or framework? b. Do we promote less formal routes to receiving and giving help based on natural relationships, and consider them part of an overall continuum or framework of supportive services? c. At the elementary level, do we give attention to improving the educational environment, developing parenting skills, reducing social exclusion and aggressive and disruptive behaviour? d. Do we approach targeted initiatives, particularly at the middle- and high-school levels, with caution to avoid labelling students? e. Are there opportunities for assessment and clear referral routes to services in the community for students with ongoing severe academic and health issues? Describe your eorts and results:

57
15.
Have we prepared, implemented and maintained relevant policies?

FULLY
PARTIALLY
UNDER DEVELOPMENT
NOT DONE
Consider: a. Have we framed our policy within broad school aims or a health-promoting schools policy? b. Does our policy include: a rationale; policies and actions in relation to substance abuse prevention, intervention, infractions and disciplinary measures; roles and responsibilities; a communications plan; and a schedule for regular review? c. Did we seek broad representation from the school community to develop the policy and emphasize a participatory approach to development? d. Does our policy show preference for instructive and health-promoting resolutions to issues (e.g., drawing students in as opposed to punishing and isolating them)? e. Does our policy seek to help high-risk youth maintain links with school whenever possible? Describe your eorts and results:

16.
Did we conduct a process evaluation of our initiative?

FULLY
PARTIALLY
UNDER DEVELOPMENT
NOT DONE
Consider: a. Did we plan the process evaluation while planning the initiative itself ? b. Did we gather information on how many students were reached? c. Did we gather information on the acceptability of our activities for participants and other stakeholders? d. Do we know the extent to which activities were conducted as planned? e. Did we note human, financial and material resources used? Describe your eorts and results:

59
17.
Did we conduct an outcome evaluation of our initiative?

FULLY
PARTIALLY
UNDER DEVELOPMENT
NOT DONE
Consider: a. Did we specify measurable indicators for each of our objectives while planning the initiative? b. Did we collect baseline data on these indicators before the initiative got started? c. Did we use an evaluation design that gives us confidence in the results? d. Have we shared the results in a report and used them to improve our initiative? Describe your eorts and results:

18.
Have we accounted for costs associated with our initiative?

FULLY
PARTIALLY
UNDER DEVELOPMENT
NOT DONE
Consider: a. In accounting for our initiatives costs, have we clearly defined what to include? b. Have we estimated costs to partners and participants? c. Have we prepared an analysis or discussion of costs in relation to the effects of our initiative? Describe your eorts and results:

61
Canadian Standards Rating Sheet
Fully in place
Partly in place
Under development
Not done
A. Assess the situation 1. Account for current activities 2. Learn relevant protective and risk factors 3. Determine local substance use patterns and harms 4. Clarify perceptions and expectations 5. Assess resources and capacity to act B. Prepare a clear and realistic plan 6. Ensure goals address relevant factors and priority harms 7. Engage students in design of the initiative 8. Determine areas of leadership, cooperation and support C. Build capacity and sustainability 9. Conduct ongoing professional development and support 10. Address sustainability of the initiative 11. Connect with parents and community initiatives D. Implement a comprehensive initiative 12. Cultivate a positive health-promoting school climate for all 13. Deliver developmentally appropriate classroom instruction at all levels 14. Organize targeted activities within a comprehensive continuum 15. Prepare, implement and maintain relevant policies E. Evaluate the initiative 16. Conduct a process evaluation of the initiative 17. Conduct an outcome evaluation of the initiative 18. Account for costs associated with the initiative
4.
SECTION FOUR: Appendix

a lack of relevant research. Scientific knowledge continues to evolve and may in time inform these areas. To address the limitations of the method used for this first edition of the Standards, the Task Force recommends that a plan to draw upon expert opinion from Canadian practitioners be incorporated into the methodology for revising these Standards and preparing the second edition. Terminology: This document uses the term substance abuse to refer to problematic use of substances. The term substance use problem has been considered most precise and inclusive because it refers to both substance abuse and substance dependence, as defined by the Diagnostic and Statistics Manual of Mental Disorders [DSM] IV (American Psychiatric Association, 1994). However, because the term substance use problem is long, and because research has questioned the validity of the distinction between abuse and dependence for adolescents (Fulkerson et al., 2002; Caetano and Babor, 2006), the term substance abuse is used. Detailed steps: Following is the method used to draft version 1 of the Standards. CCSA will regularly evaluate the Standards, seeking feedback from users and experts, and revise as necessary. Step 1: Initial Standards were drafted from evidence reported in credible Canadian reviews of the school-based prevention literature, or guidelines based on this literature, published in the past 10 years. Step 2: Task Force Force reviewed the first draft for gaps or other inadequacies. Step 3: Where information or consensus was lacking, the Task Force referred to other credible sources (international reviews of the literature) to prepare a second draft (see below). Step 4: When a lack of consensus among experts on a Standard persisted, the Task Force conducted a targeted search of primary studies published since the most recent relevant review to fully clarify the evidence.
METhODOLOgY
The effects of prevention and health promotion activities cannot always be known precisely. It is difficult to be certain that a particular initiative was responsible for something not occurringfor example, that a specific program has reduced substance use problems in a school rather than some other factor. Scientific research aims to clarify the links between activities and outcomes, increasing confidence that a particular program or initiative was responsible for the desired change. The findings of thousands of studies on school-based substance abuse prevention, child development and health promotion have greatly increased our understanding of what works and what doesnt (the review articles listed below summarize this body of work). A number of reviews and meta-analyses of this extensive literature have been conducted over the past 10 years to help draw conclusions on effective practice. Most of these reviews are credible in that they clearly indicate their objectives and search methods and limit their analyses to well-designed evaluation studies. Several Canadian reports have summarized the international peer-reviewed school-based substance abuse prevention literature, drawing largely on these credible reviews. This first edition of the Canadian Standards is based primarily on the conclusions and recommendations of these Canadian reports. Where a need for information on areas of practice not covered by the Canadian reports was identified, the Task Force referred to selected international reviews or recent well-designed primary studies in peer-reviewed literature that would not have been captured in the reviews. The Task Force views the scientific literature as a firm foundation on which to establish standards, yet most of the research on this topic is based in the United States and may not always be generalized to Canadian schools. The Task Force also understands that reliance on this literature may result in gaps in the Standards because of
63
Step 5: Selected end users identified by the Task Force reviewed the draft Standards document for ease of understanding and relevance to their daily realities (language, terms, etc.). Step 6: The Task Force made the final decision on whether to include a Standard, how to define it and choice of final wording.
SOURCEs: Canadian
1. Canadian Association for School Health (Draft, awaiting publication). School-based and school-linked prevention of substance use problems: A knowledge summary. Surrey, BC: Authors. Health Canada (2002). Preventing Substance Use Problems among Young People: A Compendium of Best Practices. Ottawa: Authors. Paglia, A., & Room, R. (1999). Preventing substance use problems among youth: A literature review and recommendations. Journal of Primary Prevention, 20(1), 3-50. 10. Skara, S., & Sussman, S. (2003). A review of 25 long-term adolescent tobacco and other drug use prevention program evaluations. Preventive Medicine, 37, 451-474. 11. Toumbourou, J.W., Rowland, B., Jefferies, A., Butler, H., & Bond, L. (2004). Preventing drug-related harm through school re-organisation and behavior management [Prevention research evaluation report]. Melbourne, Australia: Australia Drug Foundation. 12. Toumbourou, J.W., Stockwell, T., Neighbors, C., Marlatt, G.A., Sturge, J., & Rehm, J. (2007). Interventions to reduce harm associated with adolescent substance use: An international review. Lancet, 369, 1391-1401. 13. White, D., & Pitts, M. (1998). Educating young people about drugs: A systematic review. Addiction, 93(10), 1475-1487.
2. 3.
International
1. 2. Cuijpers, P. (2002). Effective ingredients of school-based drug prevention programs: A systematic review. Addictive Behaviors, 27(6), 1009-1023. Foxcroft, D., Ireland, D.J., Lister-Sharp, D., Lowe, G., & Breen, R. (2003). Longer-term primary prevention for alcohol misuse in young people: A systematic review. Addiction, 98, 397-411. Godfrey, C., Toumbourou, J.W., Rowland, B., Hemphill, S., Munro, G., & Farrell, C. (2002). Drug education approaches in primary schools. Melbourne: Australian Drug Foundation. Gottfredson, D.C., & Wilson, D.B. (2003). Characteristics of effective schoolbased substance abuse prevention. Prevention Science, 4(1), 27-38. Hawks, D., Scott, K., & McBride, M. (2002). Prevention of psychoactive substance use: A selected review of what works in the area of prevention. Geneva: World Health Organization. Loxley, W., Toumbourou, J.W., & Stockwell, T. (2004). The prevention of substance use, risk and harm in Australia: A review of the evidence. Perth, Australia: Australian Government, Department of Health and Aging. McBride, N. (2003). A systematic review of school drug education. Health Education Research: Theory and Practice, 18(6), 729-742. McGrath, Y., Sumnall, H., McVeigh, J., & Bellis, M. (2006). Drug use prevention among young people: A review of reviews [Evidence briefing update]. London, United Kingdom: National Institute for Health and Clinical Excellence. Nation, M., Crusto, C., Wandersman, A., Kumpfer, K.L., Seybolt, D., Morrissey-Kane, E., & Davino, K. (2003). What works in prevention. Principles of effective prevention programs. American Psychologist, 58(6/7), 449456.
3.
4. 5.
6.
7. 8.
9.
65
BIBLIOgRAPhY
1
Stewart-Brown, S. (2006). What is the evidence on school health promotion in improving health or preventing disease and, specifically, what is the effectiveness of the health promoting schools approach? Geneva: World Health Organization.
France, A., & Homel, R. (2006). (Eds). Societal access routes and developmental pathways. Putting social structure and young peoples voice into the analysis of pathways into and out of crime. Special Issue of Australian and New Zealand Journal of Criminology, 39(3).
12
Knight, Cecily. (2007). A resilience framework: Perspectives for educators. Health Education. 107(6), 543-555.
13 14 Weissberg, R., Kumpfer, C., & Seligman, M. (2003). Prevention That Works for Children and Youth: An Introduction. American Psychologist 58(6/7), 425432.
Tobler, N.S. (2000). Lessons learned. The Journal of Primary Prevention, 20(4), 261-274.
2
Bryant, A.L., Schulenberg, J.E., OMalley, P.M., Bachman, J.G., & Johnston, L.D. (2003). How academic achievement, attitudes, and behaviors relate to the course of substance use during adolescence: A 6-year, multiwave national longitudinal study. Journal of Research on Adolescence, 13(3), 361397.
3
Mallick, J., & Watts, M. (2007). Personal Construct Theory and constructivist drug education. Drug and Alcohol Review, 26(6), 595-603.
15
Cox, R.G., Zhang, L., Johnson, W.D., & Bender, D.R. (2007). Academic performance and substance use: Findings from a state survey of public high school students. Journal of School Health, 77, 109-115.
4
Dell, C.A., & Poole, N. (2008). Worksheet: Applying a Sex/Gender/DiversityBased Analysis within the National Framework for Action to Reduce the Harms Associated with Alcohol and Other Drugs and Substances in Canada.
16 17
Lynskey, M. (2006). Commentaries on King et al. and Engberg and Morral (this issue). Substance use and educational attainment. Addiction, 101, 1684-1689.
5
Harrison, S., & Ingber, E. (2004). Working with women. In S. Harrison, & V. Carver (Eds.), Alcohol and drug problems: A practical guide for counsellors. Toronto: Centre for Addiction and Mental Health.
Aldridge, J. (2008). Guest Editorial: A hard habit to break? A role for substance use education in the new millennium. Health Education, 108(3), 185-188.
6
18 Gliksman, L., Demers, A., Adlaf, E.M., Newton-Taylor, B., & Schmidt, K. (2000). Canadian campus survey 1998. Toronto, Canada: Centre for Addiction and Mental Health. 19
7 8
Blake, S.M., Amaro, H., Schwartz, P.M., & Flinchbaugh, L.J. (2001). Developing theory-based substance abuse prevention programs for young adolescent girls. Journal of Early Adolescence, 21(3), 256-293.
Loxley, W., Toumbourou, J.W., & Stockwell, T. (2004). The prevention of substance use, risk and harm in Australia: A review of the evidence. National Drug Research Institute and the Centre for Adolescent Health. Australia: Author.
DeWit, D.J., Akst, L., Braun, K., Jelley, J., Lefebvre, L., & McKee, C. (2002). Sense of school membership: A mediating mechanism linking student perceptions of school culture with academic and behavioural functioning. Toronto, Canada: Centre for Addiction and Mental Health.
20
9
Saewyc, E. Substance use among non-mainstream youth. In (Eds). Canadian Centre on Substance Abuse. (2007). Substance Abuse in Canada: Youth in Focus: Ottawa, ON: Canadian Centre on Substance Abuse.
21 22 Bontempo, D., & DAugelli, A. (2002). Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths health risk behavior, Journal of Adolescent Health, 30, 364-374.
World Health Organization. Global school health initiative. Geneva: Author. http://www.who.int/school_youth_health/gshi/en/
10 11
International Union for Health Promotion and Education (IUHPE). (2006). Protocols and Guidelines for Health Promoting Schools. St Denis Cedex, France: Author.
University of Calgary, Population health intervention research centre. (n.d.). Feeling alienated at school: How risky health behaviours start. Calgary: Author.
23
McNeely, C., & Faici, C. (2004). School connectedness and the transition into and out of health-risk behavior among adolescents: A comparison of social belonging and teacher support. Journal of School Health, 74(7).
24
Agic, B. (2004). Culture counts: Best Practices in Community Education in Mental Health and Addiction with Ethnoracial/Ethnocultural Communities Phase One Report. Toronto: Centre for Addiction and Mental Health.
25 26 Statistics Canada (2001). Aboriginal peoples of Canada: A demographic profile. Ottawa, Canada: 96F0030XIE2001007.
Roberts, G., Comeau, N., Boak, A., Patton, D., Lane, J., Naidoo, K., & Krank, M. (2007). School-based and school-linked prevention of substance use problems: A knowledge summary. Surrey, BC: Canadian Association for School Health.
38 39 Godfrey, C., Toumbourou, J.W., Rowland, B., Hemphill, S., Munro, G., & Farrell, C. (2002). Drug education approaches in primary schools [Prevention research evaluation report No. 4]. Melbourne, Australia: Australia Drug Foundation.
van der Woerd, K.A., Dixon, B.L., McDiarmid, T., Chittenden, M., Murphy, A., & The McCreary Centre Society (2005). Ravens children II: Aboriginal youth health in BC. Vancouver, Canada: The McCreary Centre Society.
27
Erickson, P.G., & Butters, J.E. (2005). How Does the Canadian Juvenile Justice System Respond to Detained Youth with Substance Use Associated Problems? Gaps, Challenges, and Emerging Issues. Substance Use & Misuse, 40,(7), 953-973.
28
Centre of Excellence for Youth Engagement. (n.d.). What is youth engagement? Toronto: The Students Commission.
40
Brown, J., Knol, D., Prevost-Derbecker, S., & Andrushko, K. (2007). Housing for Aboriginal Youth in the Inner City of Winnipeg. The First Peoples Child & Family Review, 3, 27-36.
29 30 Anderson, J. (2003). Aboriginal Children in Poverty in Urban Communities: Social exclusion and the growing racialization of poverty in Canada. Ottawa: Canadian Council on Social Development. 31
World Health Organization. Ottawa Charter for Health Promotion. First International Conference on Health Promotion. Ottawa, 21 November 1986 WHO/HPR/HEP/95.1.
41 42
Allensworth, D., (1994). The Research Base for Innovative Practices in School Health Education at the Secondary Level. Journal of School Health, 64(5), 180-187.
First Nations Child and Family Caring Society of Canada (2003). United Nations Committee on the rights of the child. Non-discrimination and diversity. Ottawa: Author.
Bond, L., Glover, S., Godfrey, C., Butler, H., & Patton, G.C. (2001). Building capacity for system-level change in schools: Lessons from the gatehouse project. Health Education and Behavior, 28(3), 368-383.
43 44 Flay, B. (2002). Positive youth development requires comprehensive health promotion programs. American Journal of Health Behavior, 26(6):407-24.
Stockwell, T.R., Toumbourou, J., Letcher, P., Smart, D., Sanson, A., & Bond, L. (2004). Risk and protection factors for different intensities of adolescent substance use: When does the prevention paradox apply? Drug and Alcohol Review. 23(1), 67-77.
32
Perry, C. L., Williams, C. L., Komro, K.A., Veblen-Mortenson, S., Stigler, M.H., & Munson, K. (2002). Project northland: Long-term outcomes of community action to reduce adolescent alcohol use. Health Education and Behavior, 17(1), 117-132.
45
National School Climate Center (2007). The school climate challenge: Narrowing the gap between school climate research and school climate policy, practice guidelines and teacher education policy.
33 34 Stockwell, T.R., Toumbourou, J., Letcher, P., Smart, D., Sanson, A., & Bond, L. (2004). Risk and protection factors for different intensities of adolescent substance use: When does the prevention paradox apply? Drug and Alcohol Review. 23(1), 67-77. 35
Wagenaar, A.C., Gehan, J.P., Jones-Webb, R., Toomey, T.L., Forster, J.L., Wolfson, M. & Murray, D.M. (1999). Communities mobilizing for change on alcohol: Lessons and results from a 15-community randomized trial. Journal of Community Psychology, 27, 315-326.
46
Hoyle, T, Samek, B & Valois, R. (2008). Building capacity for the continuous improvement of health-promoting schools. Journal of School Health. 78 (1),1-8.
47 48 Canadian Association for School Health. (Revised 2007). Canadian consensus statement: comprehensive school health. Surrey, BC: Author.
Lerner, R.M., Dowling, E.M., & Anderson, P.M. (2003). Positive youth development: Thriving as the basis of personhood and civil society. Applied Developmental Science. 7(3), 172180.
36
Damon, W. (2004). What is positive youth development? The ANNALS of the American American Academy of Political and Social Science. 591, 13-24.
Bond, L., Glover, S., Godfrey, C., Butler, H., & Patton, G.C. (2001). Building capacity for system-level change in schools: Lessons from the gatehouse project. Health Education and Behavior, 28(3), 368-383.
49
Poulin, C., & Nicholson, J. (2005). Should harm minimization as an approach to adolescent substance use be embraced by junior and senior high schools? Empirical evidence from an integrated school and communitybased demonstration intervention addressing drug use among adolescents. International Journal of Drug Policy, 16, 403414.
37
Hawks, D., Scott, K., & McBride, M. (2002). Prevention of psychoactive substance use: A selected review of what works in the area of prevention. Geneva: World Health Organization.
50
67
51
World Health Organization. (2003). Skills for Health. Skills-based health education including life skills: An important component of a Child-Friendly/ Health-Promoting School. Geneva: Author.
52 Mallick, J., & Watts, M. (2007). Personal construct theory and constructivist drug education. Drug and Alcohol Review. 26(6), 595-603.
Adelman, H.S., & Taylor, L. (2003). Creating school and community partnerships for substance abuse prevention programs. Commissioned by SAMHSAs Center for Substance Abuse Prevention. The Journal of Primary Prevention, 23, 331-369.
63 64 National School Climate Center, Center for Social and Emotional Education, National Center for Learning and Citizenship. (2007). The school climate challenge: Narrowing the gap between school climate research and school climate policy, practice guidelines and teacher education policy. USA: Author.
McBride, N., & Farringdon, F. (2004). School health and alcohol harm reduction project: Changing students alcohol related behaviors through classroom lessons in Western Australia. Education and Health, 22(2), 19-23.
53
Murnane, A., Snow, P., Farringdon, F., Munro, G., Midford, R., & Rowland, B. (2002). National school drug education strategy. Effective implementation practice in relation to school drug education. Perth, Australia: National Drug Research Institute, Curtin University.
54
Bonell, C., Fletcher, A., & McCambridge, J. (2007) Improving school ethos may reduce substance misuse and teenage pregnancy. British Medical Journal, 334, 614-616.
65
Barnekow, V., Buijs, G., Clift, S., Jensen, B.B., Paulus, P., Rivett, D., & Young, I. (2006). Health-promoting schools: A resource for developing indicators. Rdovre, Netherlands: European Network of Health Promoting Schools.
55 56 Gray, G., Young, I., & Barnekow, V., (2006). Developing a health-promoting school. A practical resource for developing effective partnerships in school health, based on the experience of the European Network of Health Promoting Schools. Netherlands: European Network of Health Promoting Schools.
Bisset, S., Markham, W.A., & Aveyard, P. (2007). School culture as an influencing factor on youth substance use. Journal of Epidemiology and Community Health, 61, 485-490.
66
Toumbourou, J.W., Stockwell, T., Neighbors, C., Marlatt, G.A., Sturge, J., & Rehm, J. (2007). Interventions to reduce harm associated with adolescent substance use: An international review. Lancet, 369, 1391-1401.
67 68 Cohen, J. (2006). Social, emotional, ethical and academic education: Creating a climate for learning, participation in democracy and well-being. Harvard Educational Review, 76, 201-237.
Toumbourou, J.W., Rowland, B., Jefferies, A., Butler, H., & Bond, L. (2004). Preventing drug-related harm through school re-organisation and behavior management [Prevention research evaluation report No. 12]. Melbourne, Australia: Australia Drug Foundation.
57
Adelman, H.S., & Taylor, L. (2003). Creating school and community partnerships for substance abuse prevention programs. Commissioned by SAMHSAs Center for Substance Abuse Prevention. The Journal of Primary Prevention, 23, 331-369.
58
National School Climate Center, Center for Social and Emotional Education, National Center for Learning and Citizenship. (2007). The school climate challenge: Narrowing the gap between school climate research and school climate policy, practice guidelines and teacher education policy. USA: Author.
69
Toumbourou, J.W., Rowland, B., Jefferies, A., Butler, H., & Bond, L. (2004). Preventing drug-related harm through school re-organisation and behavior management [Prevention research evaluation report No. 12]. Melbourne, Australia: Australia Drug Foundation.
59 60 Adelman, H.S., & Taylor, L. (2003). Creating school and community partnerships for substance abuse prevention programs. Commissioned by SAMHSAs Center for Substance Abuse Prevention. The Journal of Primary Prevention, 23, 331-369. 61
Sellstrm, E., & Bremberg, S. (2006). Is there a school effect on pupil outcomes? A review of multilevel studies. Journal of. Epidemiology and Community Health, 60,149-155.
70
Wood, E.J., Dewit, D.J., Rye, B.J., Stevens Lavigne, A., Steep, B., Silverman, G., Ellis, K., Smythe, C., & Braun, K. (2000). Evaluating an in-school drug prevention program for at-risk youth. Alberta Journal of Educational Research, 46(2), 117.
71 72
Inchley, J., Muldoon, J., & Currie, C. (2007). Becoming a health-promoting school: Evaluating the process of effective implementation in Scotland. Health Promotion International, 22(1), 65-71.
DeWit, D.J., Akst, L., Braun, K., Jelley, J., Lefebvre, L., & McKee, C. (2002). Sense of school membership: A mediating mechanism linking student perceptions of school culture with academic and behavioural functioning. Toronto, Canada: Centre for Addiction and Mental Health.
62
73
Aggleton, P., Whitty, G., Knight, A., Prayle, D., Warwick, I., & Rivers, K. (1998). Promoting young peoples health: the health concerns and needs of young people, Health Education, 98, 213-19.
74 75 World Health Organization. (2003). Skills for Health. Skills-based health education including life skills: An important component of a Child-Friendly/ Health-Promoting School. Geneva: Author. 76
Conrod, P., Stewart, S., Comeau, N., & Maclean, A.M. (2006). Efficacy of cognitivebehavioral interventions targeting personality risk factors for youth alcohol misuse. Journal of Clinical Child and Adolescent Psychology, 35(4), 550-563.
88 89 Dishion, T.J., Andrews, D.W. (1995). Preventing Escalation of Problem Behaviors with High-Risk Young Adolescents: Immediate and 1-Year Outcomes. Journal of Consulting and Clinical Psychology, 63(4), 538-548.
Peters, L., Wiefferink, C, Hoekstra, F, Buijs, G., ten Dam, G & Paulussen, G. (2008). A review of similarities between domain-specific determinants of four health behaviors among adolescents Health Education Research, 24(2):198223
UCLA Center for Mental Health in Schools (2007, 2008). School mental health project. Los Angeles: Author.
90 91
Scottish Health Promoting Schools Unit. (2004). Being well - doing well. Government of Scotland, Edinburgh, Scotland: Author.
77
Aboriginal Healing Foundation (2004). Historic Trauma and Aboriginal Healing. Ottawa: Author.
78 79
Roberts, G., Comeau, N., Boak, A., Patton, D., Lane, J., Naidoo, K., & Krank, M. (2007). School-based and school-linked prevention of substance use problems: A knowledge summary. Surrey, BC: Canadian Association for School Health.
92 93 Toumbourou, J.W., Rowland, B., Jefferies, A., Butler, H., & Bond, L. (2004). Preventing drug-related harm through school re-organisation and behavior management [Prevention research evaluation report No. 12]. Melbourne: Australia Drug Foundation.
Tobler, N.S. (2000). Lessons learned. The Journal of Primary Prevention, 20(4), 261-274.
Mallick, J. & Watts, M. (2007). Drugsbridge: A humanistic approach to drug education. Research in Education. 78, 110-128.
80
Mallick, J., & Watts, M. (2007). Personal construct theory and constructivist drug education. Drug and Alcohol Review. 26(6), 595-603.
81
McBride, N. (2003). A systematic review of school drug education. Health Education Research: Theory and Practice, 18(6), 729-742.
82 83 Gray, G., Young, I., & Barnekow, V., (2006). Developing a health-promoting school. A practical resource for developing effective partnerships in school health, based on the experience of the European Network of Health Promoting Schools. Netherlands: European Network of Health Promoting Schools.
Hemphill, S., Toumbourou, J., Herrenkohl, T., McMorris, B., & Catalano, R. (2006). The effect of school suspensions and arrests on subsequent adolescent antisocial behavior in Australia and the United States. Journal of Adolescent Health, 39(5), 736-744.
94 95
Alberta Alcohol and Drug Abuse Commission. (nd). Developing substance use and gambling policies for Alberta schools. Edmonton: Author.
Parry-Langdon, N., Bloor, M., Audrey, S., & Holliday, J. (2003). Process evaluation of health promotion interventions. Policy & Politics, 31(2), 20716.
96 97 Victorian Government Department of Human Services. (2003). Measuring health promotion impacts: A guide to impact evaluation in integrated health promotion. Melbourne: Author.
McBride, N., & Farringdon, F. (2004). School health and alcohol harm reduction project: Changing students alcohol related behaviors through classroom lessons in Western Australia. Education and Health, 22(2), 19-23.
84
UCLA Center for Mental Health in Schools (2007, 2008). School mental health project. Los Angeles: Author.
85 86
Toumbourou, J.W., Stockwell, T., Neighbors, C., Marlatt, G.A., Sturge, J., & Rehm, J. (2007). Interventions to reduce harm associated with adolescent substance use: An international review. Lancet, 369, 1391-1401.
Caulkins, J.P., Everingham, S., Rydell, P., Chiesa, J., & Bushway, S. (1999). An Ounce of Prevention, A Pound of Uncertainty: The Cost Effectiveness of School-Based Drug Prevention Programs. Santa Monica, CA: RAND Drug Policy Research Center.
98
87 Webster-Stratton, C., & Taylor, T. (2001). Nipping early risk factors in the bud: Preventing substance abuse, delinquency, and violence in adolescence through interventions targeted at young children (08 Years). Prevention Science, 2(3), 165-192.
Godfrey, C. & Parrott, S. (1998).The Cost Effectiveness of Drug Prevention. In: Evaluating Drug Prevention in the European Union. Lisbon: European Monitoring Centre on Drugs and Drug Abuse.
99 100
McGrath, Y., Sumnall, H., McVeigh, J., & Bellis, M. (2006). Drug use prevention among young people: A review of reviews [Evidence briefing update]. London, United Kingdom: National Institute for Health and Clinical Excellence.
69

Ccsa0117812009 - e 1

Загружено:

Сведения о документе

Исходное описание:

Оригинальное название

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

Ccsa0117812009 - e 1

Загружено:

Авторское право:

Доступные форматы

BUILDING

Canadian Standards for Youth Substance Abuse Prevention

A component of CCSAs Drug Prevention Strategy for Canadas

BUILDING ON OUR STRENGTHs

SECTION ONE: An Invitation

Canadian Centre on Substance Abuse 2009. All rights reserved.

Canadian Centre on Substance Abuse 2009. All rights reserved.

Defining school-based substance abuse prevention

Canadian Centre on Substance Abuse 2009. All rights reserved.

Canadian Centre on Substance Abuse 2009. All rights reserved.

SECTION TWO: Canadian Standards

1. Frame substance abuse prevention within a health-promoting school approach

2. Community responsibility, knowledge, and resources are key

3. Give attention to development pathways

4. Promote positive youth development and resiliency

10 Canadian Centre on Substance Abuse 2009. All rights reserved.

5. Understand and engage diverse student populations

Canadian Centre on Substance Abuse 2009. All rights reserved.

Canadian Centre on Substance Abuse 2009. All rights reserved.

capacity and sustainability

12. 13. 14. 15.

16. 17. 18.

14 Canadian Centre on Substance Abuse 2009. All rights reserved.

A. AssEss ThE sITUATION 1. Account for current activities

2. Learn relevant protective and risk factors

3. Determine local substance use patterns and harms

16 Canadian Centre on Substance Abuse 2009. All rights reserved.

4. Clarify perceptions and expectations

Canadian Centre on Substance Abuse 2009. All rights reserved.

5. Assess resources and capacity to act

18 Canadian Centre on Substance Abuse 2009. All rights reserved.

Canadian Centre on Substance Abuse 2009. All rights reserved.

RESOURCES ACTIVITIES OBJECTIVES GOALS

Canadian Centre on Substance Abuse 2009. All rights reserved.

7. Engage students in design of the initiative

8. Determine areas of leadership, cooperation and support

Canadian Centre on Substance Abuse 2009. All rights reserved.

10. Address sustainability of the initiative

26 Canadian Centre on Substance Abuse 2009. All rights reserved.

11. Connect with parents and community initiatives

28 Canadian Centre on Substance Abuse 2009. All rights reserved.

13. Deliver developmentally appropriate classroom instruction at all levels

30 Canadian Centre on Substance Abuse 2009. All rights reserved.

SKills to GeNeral PriNciPles OF reFusiNg cigarette

APPlYiNg tHese PriNciPles to reFusiNg alcoHol or uNsaFe seX

Canadian Centre on Substance Abuse 2009. All rights reserved.

32 Canadian Centre on Substance Abuse 2009. All rights reserved.

14. Organize targeted activities within a comprehensive continuum

15. Prepare, implement and maintain relevant policies

36 Canadian Centre on Substance Abuse 2009. All rights reserved.

E. EVALUATE ThE INITIATIVE 16. Conduct a process evaluation of the initiative

Canadian Centre on Substance Abuse 2009. All rights reserved.

17. Conduct an outcome evaluation of the initiative

38 Canadian Centre on Substance Abuse 2009. All rights reserved.

18. Account for costs associated with the initiative

Canadian Centre on Substance Abuse 2009. All rights reserved.

SECTION THREE: Workbook

Canadian Centre on Substance Abuse 2009. All rights reserved.

42 Canadian Centre on Substance Abuse 2009. All rights reserved.

Canadian Centre on Substance Abuse 2009. All rights reserved.

Have we fully accounted for the prevention activities already occurring?

Supporting documentation attached o