Universal programmes aim to reach the general population or smaller defined groups. These can be run in various settings, including schools, youth services and family services and can take a number of forms.
Information
Increased knowledge and understanding of any problem helps us to deal with it at a personal level and at a community level. It is necessary that we understand the nature of the local drug situation, the facts about the drugs that are available and are being used locally, and the consequences of substance misuse. In order to help prevent problems and reduce harm, it is of primary importance that people know what is effective in prevention. It is essential that when agencies are intending to run education, information, or training programmes that they know of what is already being done and that they get advice on targeting and using the most effective model available.
Parent support programmes
Parents are a crucial influence in the behaviour of their children. Most parents recognise the growing number of issues that can impact on the wellbeing of young people today, including binge drinking, smoking, illicit drug use, antisocial behaviour, bullying, suicide, eating disorders, road safety and others. Parents need to be knowledgeable about how to tackle these issues, and should be encouraged to seek help early if problems are suspected or identified. There are a growing number of parenting programmes and education programmes available that can assist parents to address such problems. These are not as successful if done in an ad hoc fashion, however. Parent support is essential in prevention efforts: "the benefits of parent education have been shown to be effective [and] parent education is therefore one of a range of family support interventions" (Watters & Byrne, 2004). It is also important that parent support programmes link in a cohesive way with education and prevention efforts in schools.
Generic youth work initiatives
It is advisable to provide universal Youth Work programmes in all localities to offer a safe and respectful space for young people to socialise. Many youth clubs already exist thanks to the tireless work of volunteers and parents. These initiatives should be supported, and helped to access or develop appropriate local facilities. The National Development Plan (Dept. of Finance, 1999) contains a number of important measures relating to youth, including the Youth Service Grant Scheme, Youth Information Centres, and Community-based Youth Initiatives. Other measures directed towards at-risk youth include Special Projects for Disadvantaged Youth, the Young People's Facilities and Services Fund and the Gárda Youth Diversion Programme. Because these measures are spread across a number of government departments, efforts to ensure coherence are particularly important (NDP/CSF Evaluation Unit, 2003).
It is very important with such youth interventions, and social inclusion measures generally, that there is a strong commitment to proper resourcing and to the effective use of those resources through coordination, integration and elimination of duplication. Social inclusion and the importance of service coordination are discussed in Chapter 4.
The Young People's Facilities & Services Fund (YPFSF) has been administered since January 2003 by the Department of Community, Rural & Gaeltacht Affairs (CRAGA) and routed through the VECs. The Fund targets disadvantaged young people aged 10-21, including those who are at risk of drug use. At present there are a small number of projects in the GMR area that have been funded by the YPFSF, all of which are in Galway : Bohermore Teenage Development Project, Ballybane Adventure Programme, Circles, the Peer Education Programme and the Le Chéile Rahoon Youth Project. Projects of this type should be set up where needed throughout the GMR region, drawing on the funding available through the YPFSF and other sources. The location of the YPFSF in CRAGA offers opportunities for links to other activities such as local and community development, RAPID, CLÁR and the Regional Drugs Task Force. A mid-term evaluation of the Border, Midland and West Regional Operational Plan (Fitzpatrick Associates, 2003) found that spending in the YPFSF up to that time was substantially below target - due to "lack of demand" and "poor promotion" of the measure - and recommended a 60% reduction in the budget for 2004-2006. However, the Task Force expects that spending will significantly increase as initiatives to address gaps in services for young people, as identified in this Strategy, are developed and implemented.
The National Youth Council has called for a number of measures to address the lack of services for young people (long-term funding, co-ordinated service provision, accessible information, and "one stop youth shops" incorporating health workers, youth workers and counsellors) and for policy and practice to be "rural proofed to ensure parity of esteem for rural youth" in keeping with the terms of the 1999 White Paper on Rural Development (National Youth Council of Ireland, 2002).
Substance use prevention & education in schools
This is an area of recurring concern for many people. Given the prevalence of substance misuse among school-goers, and their reported ease of access to alcohol and other drugs, it is very important that substance misuse education is comprehensively dealt with in schools. Research shows that drug and alcohol education is best delivered in the context of lifeskills programmes that are appropriate to the developmental stage of young people. Programmes such as these help to equip young people with the facts about drugs and the consequences of substance use, as well as empowering them to develop the confidence, attitudes and personal skills conducive to responsible decision-making.
The Social, Personal and Health Education (SPHE) programme, and the resources Walk Tall and On My Own Two Feet, have been developed with such aims in mind and with the broad objectives of promoting physical, mental, and emotional wellbeing within the framework of the school curriculum. SPHE is now part of the curriculum for all students in primary schools and in the junior cycle of post-primary schools, and is being developed for the post-primary senior cycle. Support for post-primary schools (including assistance with developing school substance use policies) is provided by the SPHE Support Service *. The national office for this service is based in Dublin and the regional support workers are based in the Western Region Health Service Executive. Support for primary schools is provided by the Primary Curriculum Support Programme; there is no dedicated SPHE support service for these schools at present.
Although SPHE can be implemented as a stand-alone subject, an integrated "whole school" approach and supportive school environment are regarded as important foundations for the programme (Dept. of Education & Science, 2000). Substance Use is one of the ten modules in the junior cycle SPHE curriculum. The Department, expressly acknowledging "concerns about the behaviour of young people in relation to alcohol, smoking . and the use of illegal substances", states that "all second level schools must timetable SPHE as part of the Junior Cycle core curriculum" (Dept. of Education & Science, 2003).
A national survey of post-primary schools, carried out before SPHE became a required part of the curriculum, found that the implementation of the programme was quite variable (Geary & Mannix, 2002). Among Secondary Schools (comprising three quarters of the survey response) the percentage offering SPHE ranged from 79% of girls' schools, to 64% of mixed schools, to 57% of boys' schools. Furthermore, the survey reported that, although the SPHE has "ten key themes for each of the Junior Cycle years, which are revisited on a year-by-year basis", the proportion of schools offering the programme decreased from 70% for First Years, to 57% for Second Years, to 46% for Third Years. The main obstacles to implementing the programme, as reported in this survey, were curriculum overload (identified by 90% of principals), lack of time for coordinating and planning (66%), and inadequate training for teachers (45%). Respondents' comments in this survey (which included the views of principals, SPHE coordinators and teachers) characterised SPHE as a qualitatively different subject in terms of both content and methodology, that had to compete for space and acceptance in a very busy exam-oriented curriculum, in circumstances where many teachers felt they would be operating outside their capabilities, class sizes were often too large for the SPHE delivery format, and opportunities for proper training were lacking. One third of principals in schools implementing SPHE reported that the topic of Substance Use was given strong emphasis in their programme, while 90% of SPHE teachers/coordinators in the survey identified Substance Use (along with Relationships and Sexuality) as being very relevant to the lives of pupils.
Since SPHE became a required part of the curriculum in September 2003, the number of schools implementing the programme has risen dramatically. There are 83 post-primary schools in the GMR region, and 80 of these have reported that they are offering the programme (SPHE Support Service, 2005). A survey of schools in the region, conducted by the SPHE Support Service in March 2004, indicated that 99% of schools were offering SPHE in 1 st Year, 64% in 2 nd Year and 41% in 3 rd Year. It may be expected that these levels will rise, since many schools not previously offering SPHE may have decided to introduce the programme incrementally, starting with 1 st Year classes in 2003. A gender breakdown of these figures is not currently available (SPHE Support Service, 2005).
The Task Force recognises SPHE as an excellent and comprehensive programme, and recommends that it should be adequately resourced and ideally implemented in its entirety in every school. It is important that the programme is delivered as developmentally appropriate throughout the school cycle, that the delivery methods follow best practice, and that all students (boys and girls) benefit from it. To ensure that the Substance Use module in particular is adequately delivered in all schools, we have identified the need for Alcohol and Drug Education Support Workers to work with the SPHE Support Service in their efforts to have the SPHE programme fully implemented in all schools in the region. Within the framework of a whole school approach, these workers would provide practical, specialist training and support for teachers and schools in relation to substance use education and policy development. This would include linking with Post Primary Support Services, Home School Liaison Officers, the VECs' Adult Education and Community Education facilitators, parent support programmes, and other relevant services and personnel.
Programmes such as SPHE, however well-implemented, cannot achieve lasting change on their own. Principals, teachers and other personnel need the support of school management boards, schools need the support of parents and governors, and all need the support of the local community. Dealing with substance abuse involves all sectors of society. Referring to alcohol in particular, Minister for Education & Science Mary Hanafin has said that the drinks industry, retailers, parents and the community as a whole must acknowledge their responsibilities and "need to reflect on the general attitude to alcohol use" (Dáil Éireann, 2005). Accordingly, we must explore how the community working together can support changes that make for a safer and healthier environment. Drugs awareness education is essential as it allows us to understand the nature of the problem and how to begin to tackle drug-related harm. However, education in its broadest sense is not just the responsibility of schools. Education must be all inclusive, and it is important that we recognise the influence of peers, adults, families and the culture that exists in our community.
Positive alternatives
Primary prevention is not simply a matter of "zero tolerance". It is also about providing positive alternatives to drug using which can delay the onset of substance use or avoid its occurrence at all. A health-promoting society provides positive initiatives that are attractive alternatives to a diverse audience, through music, arts, sport, drama, cinema, and so on. These can be done through youth services, pastoral projects, sports organisations, community centres and volunteer programmes.
A project such as "the Gaf" Health Advice Café in Galway is an example of a primary prevention initiative targeting 14-18 year olds, offering a positive space within the context of a health promotion ethos and an active learning environment. Young people are encouraged to take classes or programmes that deal with health or social issues that are age specific. The Gaf combines peer education programmes, mentoring initiatives and lifeskills training with social activities. Other positive youth development initiatives include Roscommon Youth Service and the forthcoming Open Space project in Castlebar.
Peer education
Peer education trains people of a similar age and back ground to convey information and resistance training approaches to others in there own community. This can be adults or young people. More research is required to assess the value of such interventions.
Mentoring/Buddy schemes
Mentoring is about matching the social and support needs of people with a positive/safe volunteer. These are valuable for all age groups. The Big Brother Big Sister programme is an example of a successful youth mentoring programme. But the value is there for older people as well, and it is particularly important to support such programmes in rural communities.
3.2.2 Targeted programmes for at risk groups
Assertive outreach programmes
These programmes target those who are hardest to reach working at street level to engage with groups offering brief interventions around harm reduction, personal safety, sexual health and homelessness. The objective is to encourage contacts to engage with existing services.
Child development support
The Task Force recognises the need for child development and educational interventions, particularly for children who live in disadvantaged circumstances. Such interventions include crèches, nurseries, playgroups, homework clubs, after school clubs, home/school/community liaison and related types of services (Watters & Byrne, 2004).
Family support
"The family is generally considered one of the most important locations of socialisation, and therefore of influences, for its members and especially children" (Watters & Byrne, 2004). It is therefore essential to target support at families, particularly those that are vulnerable to or have an increased exposure to substance misuse. It is important that parents are aware of their children's risk of exposure to drugs, that they know the impact drugs can have and that they are sufficiently knowledgeable about the consequences of drug misuse and how to deal with a drug problem.
In addition to these external risks, difficulties involving family management, parenting skills and levels of caring in families have all been strongly linked to substance misuse and related activities among young people. Deprivation and other pressures on family life result in increasing numbers of at-risk children, and the family thus becomes a risk factor for drug problems at societal level. Support programmes work by "diminishing family risk factors for drug problems through strengthening families" (Watters & Byrne, 2004). Properly-implemented, evidence-based support programmes for parents can, for example, help to prevent the development of antisocial behaviour in their children (Webster-Stratton, 2001). Family support programmes are multi-faceted and cover a wide array of service types and interventions, including therapeutic interventions, parent education, child development and education, home based parent and family support programmes, youth work and community development (Watters & Byrne, 2004).
The Child Care Act 1991 obliges the Health Services to provide child care and family support services. Given its broad remit in respect of promoting overall child welfare, the HSE therefore provides a wide range of family support services and programmes throughout the region that target children, adolescents, parents and families collectively. All of these programmes are part of international best practice initiatives, are evidence-based, and are reviewed and evaluated on an ongoing basis. These services are also strongly involved in and committed to helping children and families through difficult situations such as violence or problems with alcohol or drug misuse. Under the umbrella term of Family Support a diverse range of intervention types are provided, including therapeutic interventions, parent education programmes, home-based parent and family support programmes, child development and education interventions, youth work, and community development programmes. Programmes in operation throughout the GMR region deliver some or all of these interventions. These include pre and post school services, Children Act Services, community-based adolescent services (e.g. Neighbourhood Youth Projects, adolescent support projects, mentoring programmes, Teenage Health Initiative), Springboard projects and community development family support projects. Where the delivery of these services involves working directly with young people and parents experiencing difficulties in relation to substance misuse, Family Support services work in partnership with the range of substance misuse services in the area. They would play an important role in the identification of people experiencing substance misuse problems and in referring them to appropriate agencies while continuing to support the service user with other issues.
Community mobilisation
Community involvement and engagement are essential if the Task Force is to truly reflect local needs. The community development process works to engage people in developing local initiatives. The first step in any community development initiative is acknowledging that there is a problem that needs to be dealt with or addressed. Our consultation process confirmed that people are concerned about many aspects of substance misuse. People said that they "can see the problems locally but they need help to know how to tackle them".
Drug and alcohol problems impact on all generations, so the focus should not be exclusively on the behaviour of young people. Prevention efforts should benefit all citizens, and therefore community initiatives should offer a broad range of supports and explore the needs of all age groups.
The Task Force has identified a role for community liaison workers, who would cross-link with the relevant statutory and voluntary agencies in the region. This approach would help to raise awareness of substance misuse issues, identify the local impact of substance misuse, assess local service development needs, and forge interagency collaboration and joint initiatives to tackle local problems.
Diversionary interventions
Diversion projects are community-based interventions which aim to engage drug users already involved in petty theft and other crime and link them into mainstream services as an alternative to the formalised route of the criminal justice system.
* The SPHE Support Service is a partnership between the Dept. of Education & Science, the Dept. of Health & Children and the Health Service Executive, in association with the Marino Institute of Education, with funding from the National Development Plan. |
