Assignment task:
1. State the question you are evaluating and explain your rationale for choosing the question.
2. How has the program contributed to the reduction of substance use disorders in Greene County in the last year?
3. Discuss which evaluation design you used and provide the notation for the design (refer to page 365 of the McKenzie et al. textbook).
4. Explain any threats to internal validity associated with your chosen design. Discuss what you might do to reduce these threats.
5. Describe your data collection methods to be used to answer the evaluation question/to evaluate your proposed program.
6. Describe the measurement tools that would be used for data collection and explain the reliability of each tool selected.
7. Summarize the ways in which your evaluation results might be used to improve the program's quality, utility, and impact on the priority populations, and provide an explanation for why you think the results might be used in these ways.
Program Proposal to Reduce Substance Abuse Disorders in Greene County Introduction
Project Relevance and Need:
Substance abuse disorder is a pressing concern in the United States, especially in Springfield, Missouri (Markiewicz et al., n.d.). The 2022 Community Health Needs Assessment showed that 4% of individuals in Greene County, Missouri, had a substance abuse disorder, which is higher than the average rates for the United States and Missouri. With the number of overdose deaths and substance abuse disorders increasing every year, it is imperative to implement new programs to reduce these numbers (Markiewicz et al., n.d.; Riley, 2019). Police reports from 2015 through 2018 show that drug violations are rising in public schools in the area (Riley, 2019). In 2021, Greene County had 47.53 overdose deaths per 100,000 people (Missouri Department of Health and Senior Services, 2023). The overdose rate for the United States in 2021 was 32.4 per 100,000 people (Centers for Disease Control and Prevention [CDC], 2023). These staggering differences show a county-level vulnerability to overdose and substance abuse disorders (Missouri Department of Health and Senior Services, 2023; CDC, 2023).
Substance abuse is preventable and treatable, yet it costs the United States 6% of its income (Georgetown University, 2019). This translates to a cost of approximately 532 billion dollars each year. Reasons for the high societal cost of substance abuse include disease, premature death, lost productivity, theft and violence, unplanned sex, and the cost of law enforcement. Approximately 28% of deaths are traced to the use of tobacco, alcohol, or other illicit drugs. With over 62% of adults who have a substance abuse disorder with illicit drugs having started using those drugs before the age of 14, it is essential to implement prevention programs at a young age and provide treatment options.
Project Complements and Adds to Other Initiatives
Prevention and early interventions addressing substance abuse disorders allow for healthier communities and complement several other initiatives (Substance Abuse and Mental Health Services Administration [SAMHSA], 2023). Growing evidence shows that programs targeting substance abuse prevention and treatment work best when they are part of a community-based effort (Georgetown University, 2019). Due to community-based efforts making the most impact, most initiatives in the United States serve as part of a coalition (Centers for Disease Control and Prevention [CDC], 2021).
Greene County currently only has the Drug Abuse Resistance Education (DARE) program available to support substance abuse prevention efforts (Greene County Sheriff's Office, n.d.). The program is donation-supported and provided by trained individuals from the Greene County Sheriff's Office to 5th and 6th grade students. Due to resources, the program is only offered in a small fraction of Greene County Public Schools. A new program targeting substance abuse disorder prevention in public schools in this region would be able to work in tandem with the Green County Sheriff's Office to fill gaps and increase outreach and awareness within the community.
Community Description
Target Audience
The target population for the health promotion program is junior high and high school students. The goal of the program is to reduce substance abuse disorders that start at an early age due to the increasing number of adolescents reported with substance abuse disorders (Riley, 2019). Due to the need to prevent substance abuse disorders in adolescents, the primary target audiences will be school board directors, government officials, and students. These audiences are crucial to creating fully developed programs and lasting impact in the community. Health education regarding substance abuse disorder is a high-priority concern in high schools in the Springfield area as police report drug violations increasing in public schools.
The other target audience for the program is individuals who work with individuals who have substance abuse disorder and individuals with substance abuse disorder.
Geographic Locations and Sites/Settings Where Activities Will Occur
Primary prevention efforts will occur in Greene County schools (U.S. Department of Education, n.d.). This will allow the substance abuse prevention program to reach a high number of teenagers. Schools are the optimal choice because the program can help schools provide evidence-based prevention programs, mitigate risk factors that lead to students using drugs, and educate teachers, parents, and students on the dangers of drug use and how to prevent misuse and addiction. School staff can also create a safe environment and culture for students when they need recovery.
Needs Assessment
Summary of Mini-needs Assessment
The purpose of the needs assessment was to determine what socio-ecological factors influence substance abuse disorders and to collect current information as to how individuals in the community are suffering from substance abuse disorders (McKenzie et al., 2023). The needs assessment conveys a significant incidence and prevalence of substance abuse disorders in Greene County, with overdose rates being on the rise. According to Georgetown University (2019), 62% of adults who have a substance abuse disorder with illicit drugs began using them before the age of 14. With Greene County having a much higher overdose rate than the state of Missouri and the United States, prevention efforts must be increased for junior high and high school-aged children (CDC, 2023). In 2021, the overdose rate in Greene County was 47.53 per 100,000 people, while it was 32.4 per 100,000 people in the United States.
There are several treatment options in Greene County, as well as coalitions, that are working to improve accessibility to treatment. One example is Mercy Hospital and CoxHealth Hospital, which are working with Burrell Behavioral Health to begin counseling treatment at the time of admission to the hospital (Cullinan, 2023). These organizations are also working together to increase the number of employees available and improve workflow to ensure that the needs of those with substance abuse disorders are met.
With several programs working to improve accessibility to treatment, it was determined that treatment would not be the focus of the proposed program to reduce substance abuse disorders in Greene County. The needs assessment showed a gap in prevention programs available in public schools in Greene County, highlighting what the focus of the program should be. DARE is currently the only program offered, and there is not enough staff at the Greene County Sheriff's Office to cover all schools in the area (Greene County Sheriff's Office, n.d.).
Socio-ecological Factors
According to the Missouri Department of Health and Senior Services (2023), several social and economic factors may impact resources available and influence vulnerability to substance abuse disorders. These factors include but are not limited to lack of a high school education, median income, poverty, unemployment, and being uninsured. Greene County is a more vulnerable population in concerns of poverty rate (18.5%), number of uninsured individuals (11.7%), and median income ($43,175). The community was not considered vulnerable due to low high school education (8.5%) or unemployment (5.0%). This is due to Greene County having more individuals with a high school education and lower unemployment rates than the rest of the state.
Other socio-ecological factors associated with substance abuse disorder include perception of risk, physical and mental health, withdrawal symptom management, access to drugs, substance use identification and prevention education, access to peer or family support, family history, and access to naloxone (Minnesota Department of Health, 2022). With the state of Missouri being considered the meth lab capital of the United States for many years, it is essential to understand the environment of individuals who will be targeted by the prevention program (Better Addiction Care, 2023).
Stakeholders
Strategies Used to Identify Stakeholders and Build Coalitions and Partnerships
Organizations and businesses that play a role in preventing and treating substance abuse disorders would be reached out to (Community Partnership of the Ozarks, 2023). Identifying organizations and businesses that may contribute to the program early on is essential, as collaboration leads to more effective programs. Cultivating relationships with identified stakeholders will be a priority to foster collaboration in the program development and implementation process. Working with these groups can lead to a higher potential of success in a school prevention program due to these organizations having experienced staff and resources to work in tandem with a new program.
Potential stakeholders were identified online via public information (Community Partnership of the Ozarks, 2023). To engage stakeholders, a tailored presentation will be created based on the needs of the program and what stakeholder is being engaged (National Association of County and City Health Officials (NACCHO, n.d.). After presentations are assigned and delivered to potential stakeholders, the organization will follow up with each stakeholder to confirm participation.
Stakeholder Roles and Contributions
Stakeholders were chosen because they work to prevent substance abuse or treat those with substance abuse disorder in Greene County (Community Partnership of the Ozarks, 2023). Identified stakeholders include Missouri Institute of Mental Health, CoxHealth Medical Center, Mercy Hospital, Overdose Fatality Review Committee, 417SQUAD, Drug Responsibility Education and Advocacy Movement (DREAM), Ozarks Fighting Back (OFB), Underage Drinking Task Force (UDTF), Greene County Sheriff's Office, and public schools. The hospitals were chosen explicitly as this is where individuals may first receive treatment information after first having a drug overdose. Obtaining data from these stakeholders may influence new initiatives and activities to be held within schools for the prevention program.
The Greene County Sheriff's Office was chosen as another stakeholder due to its current efforts within schools to prevent substance abuse disorders (Greene County Sheriff's Office, n.d.). Requested contributions from this potential partner would be to work together to increase outreach within Greene County Schools due to the lack of resources and personnel currently available to make these programs successful.
School leaders, teachers, and staff are partners that are vital to the success of a substance abuse prevention program (U.S. Department of Education, n.d.). These individuals can create safe and positive environments for students. Requested contributions from schools would be time to educate students and time to educate personnel on effective means to reduce drug abuse among students. Training would also include how to be prepared if a drug overdose occurs on school grounds. Schools can reduce risk factors that put students at risk of abusing drugs and support students who have someone at home with a substance abuse disorder.
One notable resource for the program is the Drug-Free Communities (DFC) Support Program (CDC, 2021). The DFC program offers grants to initiate and maintain decreased youth substance use in communities. The goal of the CDC program is to establish and enhance cooperation between communities, public and private nonprofit organizations, and federal, state, local, and tribal governments to aid community coalitions that work to prevent and reduce youth substance use. The DFC program will help to address the community's contributing factors that increase the risk of substance abuse disorder and encourage factors that reduce substance use in adults and youth.
Mission, Goals, and Objectives
The mission of the program is to reduce the impact of substance abuse disorders in the Greene County community through prevention and referrals for treatment. Reducing substance abuse disorders through prevention and treatment allows the program to be flexible and meet the changing needs of the community. The goal of the program will be to reduce substance abuse disorders in Greene County. This goal can be achieved by creating clear objectives. One objective of the program will be to reduce the number of overdose deaths by 5% each year. Another objective will be to prevent and reduce the number of individuals with substance abuse disorders by providing education to high schoolers and young adults. This objective can be measured by utilizing data from the Missouri Student Survey (MSS), which is conducted every other year (Missouri Department of Mental Health, n.d.). The survey will allow the program to track changes in self-reported risk behaviors.
Theoretical Framework of Program
The Social Cognitive Theory emphasizes the dynamic interaction between individual characteristics, contextual factors, and human behavior (NIH, n.d.). This theoretical framework is a good fit for this program because it considers behavior influenced by personal characteristics, the environment, and the behavior itself and that learning will occur in social contexts. This theory is especially relevant to substance abuse prevention because it recognizes the importance of social influences and environmental factors in the initiation and maintenance of substance abuse behaviors.
Intervention Strategy
Health education is a suitable population-based program intervention that can be used to prevent substance abuse (McKenzie et al., 2023). The Social Cognitive Theory asserts that a person can be an agent for change and respond to change (National Institutes of Health [NIH], n.d.). This reciprocal determinism may mean that training peers to provide educational information for substance abuse may have a more positive impact on teenagers than if it were only professionals providing the information. Educational information that aims to increase student awareness includes the dangers of substance use, boosting confidence to withstand peer pressure and honing decision-making skills. Throughout educational efforts, it is important to consider observational learning, reinforcement, self-control, and self-efficacy. Providing education to teachers on better interacting with students to create a positive and open environment will also help students improve self-control, reinforcement of behaviors, and goal setting.
This tactic focuses on the socio-ecological aspect of interpersonal connections, such as peer pressure, which is known to influence drug usage in teens (NIH, n.d.). The program use social influence to encourage healthy habits and discourage substance use through a peer-led approach. In conjunction with the Social Cognitive Theory, the educational component addresses important personal elements that impact behavior by reinforcing the development of self-efficacy and decision-making abilities.
Activities Used in the Program and How They Relate to Theoretical Framework
Social Cognitive Theory strongly emphasizes the contributions that social experience, reciprocal determinism, and observational learning make to the formation of personality (Mcleod, 2023). It asserts that behavior, environment, and person all interact dynamically and reciprocally in a social setting during learning.
Social Cognitive Theory holds that parents have a significant influence on how their children behave (Gardner, 2011). By receiving education, parents can set an example of healthy substance-related behaviors and attitudes at home by learning about substance abuse. This can affect how teenagers behave through observational learning. In addition, parents can foster an environment that promotes healthier alternatives and discourages substance use. Providing educational workshops may also indicate to parents that they need treatment. Parents seeking treatment for substance abuse disorder would also benefit youths by providing an example.
Workshops will also be held to further educate school staff on substance abuse disorders and how to interact with students when concerns are present. Teachers and counselors are among the school staff members who regularly engage with students and significantly impact their attitudes and behaviors (United States Department of Education, n.d.). These individuals can provide accurate information, set an example of proper behavior, and foster a supportive environment that discourages substance use by learning about substance abuse (Gardner, 2011).
This is consistent with the Social Cognitive Theory's focus on how social and environmental factors influence behavior.
The idea of reciprocal determinism, which holds that people both influence and are influenced by their surroundings and social context, is consistent with the activity of having peers educate other peers about substance abuse disorders (Cherry, 2023). By involving students in creating and delivering presentations, they become active participants in their learning process. This can improve their comprehension of the subject matter, boost their self-efficacy, and give them the tools they need to constructively influence their peers.
The Social Cognitive Theory strongly emphasizes learning by direct instruction and observation, which is directly related to providing health education to youths about substance abuse disorders (Boston University, 2023). Students can make wise decisions about their behavior if they are given accurate information about substance use and its effects, as well as expectations. Additionally, by modeling positive attitudes and behaviors toward substances, the presenters can serve as role models for students to follow in their own lives.
Logic Model
The logic model shows the inputs, activities, and outputs that will take place to manifest intended short-term, mid-term, and long-term outcomes in the community (McKenzie et al., 2023). The program will require volunteers, time, staff, technology, funding, and educational materials to carry out its planned activities. Planned activities include educational workshops for parents, educational workshops for school employees, the formation and education of student teams so they can make presentations for their peers, and the creation of presentations for staff to utilize.
These activities are conducive to achieving program goals (Georgetown University, 2019). Expected outcomes include a reduction in the number of individuals who have a substance abuse disorder, a reduction in the number of overdose deaths, and a reduction in the number of youths who use drugs.
Conclusion
The proposed program aims to reduce substance abuse disorders in Greene County, Missouri, by focusing on prevention and early intervention strategies, particularly among junior high and high school students. The program is rooted in the Social Cognitive Theory, emphasizing the dynamic interaction between individual characteristics, environmental factors, and human behavior (NIH, n.d.).
The program's mission is to reduce the impact of substance abuse disorders in the Greene County community through prevention and referrals for treatment. The goal is to reduce substance abuse disorders in Greene County by reducing the number of overdose deaths by 5% each year and preventing and reducing the number of individuals with substance abuse disorders by providing education to high schoolers and young adults.
The program will involve various stakeholders, including schools, hospitals, law enforcement, and community organizations, to ensure a comprehensive and collaborative approach (Georgetown University, 2019). Activities will include educational workshops for parents and school employees, forming and educating student teams to create presentations for their peers, and creating presentations for staff to utilize.
Leadership and management principles are crucial to successfully implementing this program (Miller, 2020). Effective leadership will guide the program's direction, ensure stakeholder engagement, and foster a culture of collaboration and shared responsibility. Sound management practices will ensure efficient use of resources, effective implementation of activities, and regular monitoring and evaluation of the program's progress.
The program's implications for social change are significant (Georgetown University, 2019). The program can contribute to healthier communities, lower healthcare costs, improve productivity, and reduce crime rates by reducing substance abuse disorders. It can also foster a culture of health and well-being among young people, empowering them to make informed decisions about substance use and lead healthier lives.
In conclusion, the proposed program represents a comprehensive and collaborative approach to reducing substance abuse disorders in Greene County (Georgetown University, 2019). It underscores the importance of prevention and early intervention, stakeholder engagement, and the application of evidence-based theories and strategies. Through effective leadership and management, the program can contribute to significant social change, promoting healthier communities and empowering young people to lead healthier lives.