The preliminary evaluation of a program to help educators address the substance use/prevention needs of special students.

Abstract

Although in-school substance abuse prevention efforts have improved over the past decade, youth with disabilities have frequently been neglected by those efforts, despite the fact that they use alcohol, tobacco, and other drugs (ATOD) as must as or more than their peers. In the current pilot study special education teachers were exposed to experiences designed to enhance their skills in adapting substance abuse prevention activities and materials, and presenting them to their students. Although pilot students noted an increase in their teachers' emphasis on substance abuse prevention in their classes and their criterion-related attitudes/behaviors were somewhat higher than those observed for a group of control students, the differences between that two groups' criterion scores did not differ significantly. Several operational weaknesses in the pilot study were raised as potential explanations for the reported

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Recent research has demonstrated that youth as well as adults with disabilities often use alcohol, tobacco, and other drugs at the same or higher rates as their non-disabled peers (Substance Abuse and Mental Health Services Administration, 1998; Mogan, Genaux, & Likins, 1994). Compounding this problem are the (a) paucity of appropriate education interventions for youth with disabilities and (b) relative lack of specific skills required be teachers to address substance abuse prevention and treatment, coupled with disability issues, both of which make delivery of these services very difficult (Christian & Poling, 1997; Radnitz, Tirch, Vinciguerra, Moran, 1999).

Educators and researchers are becoming more aware that youth with disabilities are not immune to the adverse affects of alcohol and drug abuse. Most of these youth have the same access to alcohol or other drugs as their peers; therefore, they need equal access to prevention and treatment. When Morgan and colleagues (1994) asked special education teachers how often they conducted prevention activities in their classrooms over 50% said once per year or less. Only 15% reported that they conducted prevention activities once per week or more.

In addition to the general risk factors for substance abuse (e.g.,peer pressure, media enticements, stress), special education students also face many disability-specific risk factors that are largely unknown to school personnel. Whether youth with disabilities are in "self-contained" or inclusion setting ("main streamed"), they are at risk for substance abuse at least to the same extent as other children (Substance Abuse and Mental Health Services Administration, 1998). Whereas educating youth with disabilities in inclusion setting exposes them to positive learning opportunities in the classroom, they also get more exposure to peer pressure for substance use and at earlier ages. On the other hand, children in contained special education classrooms often have less socialization practice or skills and may use substances in order to feel accepted by their peers.

Substance abuse prevention efforts have improved greatly during the past decade and schools are attempting more comprehensive research-based strategies. Unfortunately, youth with disabilities have been neglected in this process. Drug free school coordinators and substance abuse counselors rarely have the necessary training to adapt traditional prevention messages for special education students. At the same time, special education teachers rarely have the necessary training in substance abuse to conduct prevention activities or identify risk factors and signs of abuse by their students. Consequently, neither the substance abuse counselor nor the special education teacher engages in educating or intervening with these students relative to substance abuse. With the preceding in mind, the purpose of the reported study was to pilot test a substance abuse prevention education program targeted toward addressing the needs of students in special education and to assess the effects of the program on participating students' related attitudes, understanding, and behavior.

Method

PALS Programs. The Prevention Works! All of us together/Learning to care! Special modifications! or PALS Program emphasizes education in basic drug use dangers as well as skill building in such areas as recognizing and resisting peer pressure, recognizing and avoiding drug using environments/situations, dealing effectively with stress, and learning how and where to communicate in a non-threatening way about drug use questions. At the same time, PALS is concerned with teaching adults who deal with children with different learning styles (parents, teachers, people in the community, etc.) to expand their personal definitions of `prevention' so they can adapt existing anti-drug and anti-violence messages for these children. Operationally, PALS is a professional development program based upon the resource guide, Alcohol, Tobacco, and Other Drug

Prevention Activities for Youth and Adults with Disabilities (Demers, 1998).

During the pilot test, all special education personnel in the experimental schools attended a day-long training session provided by PALS staff. In addition to teachers, some administrators (assistant principals, counselors, and school nurses) from the experimental schools participated in the training as well. Experimental teachers also participated in five short training sessions provided by PALS staff during the school year. These short training or "booster" sessions were held during the teachers' planning periods, so as not to disrupt their classes. At the same time, the experimental teachers were given a copy of the resource guide noted earlier (Demers, 1998), which contains a variety of concrete ideas for developing classroom-based prevention activities and other related resource information.

Research Design. To assess the effects of the PALS program on students, six high schools in the Dayton metropolitan area were identified. Using a quasi-experimental (non-equivalent control group) design procedure (Campbell and Stanley, 1966), the sample of schools divided into two groups, control and experimental, with all students in each school receiving the same "treatment." Participating students were surveyed near the beginning of the school year (T1), just after the winter break (T2), and at the end of the school year (T3) in order to see whether their attitudes and behaviors towards ATOD had changed.

Between survey administrations, students in the experimental group received specific lessons from their teachers that dealt with substance abuse prevention issues. PALS staff was present during these lessons and helped facilitate delivery of the lessons, if needed. Teachers from the experimental group were also encouraged to take advantage of "teachable moments" when they could educate their students about substance use.

Students in the control group received no PALS-related instruction from their teacher or the PALS staff. Most schools districts, however, do have substance abuse programs in place and both control and experimental students participated in these programs.

In an effort to enhance student participation in the pilot test, Paramount King's Island, an amusement park in Southwestern Ohio, donated two season passes to each student (both control and experimental) who completed all three surveys. Students who chose not to participate in the study did not complete any of the surveys, though they did stay in their classrooms during any PALS-related substance abuse education lessons.

Student Sample. A total of 138 special education students from six high schools completed all three surveys in the study. Of this sample, 73 students were in the control group and 65 students were in the experimental group. All the students had permission from their parents to participate.

Teacher Sample. There were six teachers who attended the training session inclusion teachers who attended training but did not conduct specific PALS lessons in their classrooms) in the experimental schools and seven teachers in the control schools. Some administrators also participated in the day-long training, but none sat in on the other training or participated in classroom activities.

Instrument for Students The survey instrument was developed by PALS staff. In addition to documenting selected student demographic characteristics and finding out whether they had been exposed to ATOD prevention in their classrooms, the purposes of the questionnaire were: (a) to determine whether students had ever used alcohol, tobacco, or other drugs (ATOD), (b) to determine whether they were currently using ATOD, (c) to see whether they intended to use ATOD in the future, (d) to assess their attitudes toward ATOD, (e) to evaluate the peer pressure they felt regarding ATOD use, (f) to asses their ability to get along with others, and (g) to determine whether their best friends used ATOD. The content validities of these seven criteria were documented through a review process involving a teams of five staff who are well steeped in prevention education as well as their linkages with items and instrumentation employed in previous national studies (Johnston, O'Malley, and Bachrnan, 1998 and Substance Abuse and Mental Health Services Administration, 1999). Internal consistency reliability estimates (Coefficient Alphas) for the seven criterion variables based on the T1 survey data are summarized, along with related descriptive information in Table 1.

When possible, the questions dealing with students' ATOD use were the same as items in the National High School Drug Survey and the Dayton Area Drug Survey (Falck et,al). The similarity not only served to further confirm the content validity of those items, but also provided the basis for some limited comparisons between the sample of special education students studied and regular education students.

Instrument for Teachers. PALS has been used a professional development program for training teachers for several years. Over that time, a related teacher survey instrument has been developed to assess whether teachers thought they would use the information they had learned and whether they thought the training was useful. During the pilot test, this instrument was modified slightly to serve as a pre-test and post-test that was given to the teachers and other schools personnel prior to the day-long training session, just after the day-long training, and again after the school year was completed. The instrument, in addition to demographic questions, asked teachers whether they found the training useful, whether they would use what they learned in their classrooms (or in their work, if the trainee was not a teacher), how often they thought they provided prevention messages in their classrooms, and how often they adapted existing prevention messages in their classrooms. In the end of the year version, several additional subjective, short answer questions were included to secure teachers' opinions on how to improve the program in the future. Teachers in the control group were not surveyed.

Statistical Analyses. Following processing of the pilot test data, descriptive statistics were used to assess whether teachers felt their inclusion of prevention messages in their instructional activities changed as a result of their participation in the PALS training program. Descriptive statistics were also used to summarize the ATOD-related prevalence rates for participating special education students and to compare them with the rates observed for the sample of general education students reported by Falck, et al. (1999).

Several inferential statistics were used to assess changes in students' criterion-related attitudes, awareness, and behaviors. Those assessments were based on the results of two Chi Square analyses and a series of Mann-Whitney Test (Siegel and Castellan, 1988) obtained using SPSS. Such nonparametric procedures, rather than more traditional ANOVA techniques, were employed due to the nature of the pilot-test date, e.g., severely limited score distributions on several variables and the considerable skewness inherent in a number of the dependent variables. The Chi Square analyses focused on determining whether experimental and control students differed with regard to awareness of their teachers' inclusion of ATOD prevention materials/activities in their teaching. The series of Mann-Whitney Tests was used to assess difference between control and experimental students' T3 (or end-of-year) scores on the seven outcome criteria listed in Table 1. For each of the test conducted an [varies]-level of 0.5 was used. Given the preliminary, exploratory nature of the study, a more stringent, study-wise error rate, particularly in relation to the series of Mann-Whitney Test, was not employed (Stevens, 1992).

Results

Teachers. Prior to the day-long training, and administrators were asked how often they believed they provided ATOD prevention and activities in their classroom. As is shown in Figure 1, most of the teachers at that point in time thought they never provided ATOD prevention or that they provided it very rarely. During the day-long training, teachers were taught that ATOD prevention is a large concerned with teaching students about making healthy choices and about thinking of the potential negative consequences of choices. Immediately after the day-long training, teachers were again asked how often thought they provided ATOD prevention and the results were quite different. Teachers understood that they have been providing prevention messages much more frequently than previously thought. Their estimates changed, on average, from less than once a year to about once a week.

[FIGURE 1 OMITTED]

On the end-of-year teachers unanimously expressed support for the PALS program and most were able to cite specific examples of how they thought it made a difference to their students.

Students. A total of 171 students were initially identified as participants in the study. Due to absences at critical times as well as students moving, dropping out of school, or changing their mind about participating, 138 completed all three surveys.

Of the original sample, 100 (58.8%) were male. The majority (74.9%, n=129) identified themselves as White or Caucasian, while 19.9% identified themselves as Black or African-American, 1.8% were Hispanic, 1.8% were Native American, and 1.2% indicated they belonged in the "other" category.

The distribution of students across grades was uneven, with 40.6%(n=70) in the ninth grade and 41.8%(n=71) in the tenth grade. These two grades, therefore, constituted over 80% of the sample. There were 21 eleventh graders (12.4%) and nine twelfth graders (5.3%). One potential reason for this disparity is that by the time many of these students reach the end of the tenth grade they are old enough to drop out of school and choose to do so.

An analysis of the initial (T1) survey data suggested there were no significant differences between the experimental and control groups in regard to grade level, gender, or race. In addition, reported current drug use (defined as use within the last 30 days) was compared for the control and experimental groups. No significant pre-existing difference was found on that variable either.

As indicated earlier, the data gathered in the first administration of the survey that dealt with students' current use of ATOD (i.e., use within past 30 days) were compared to data gathered by Falck, et. al. 1999, in the Dayton Area Drug Survey (DADS) in 1998. The DADS data were not gathered at all the same high schools, but all the high schools in the DADS and PALS surveys are in the Dayton metropolitan area. The results of those comparisons (see Table 2) indicate the following:

A. when only data from ninth graders are compared, the PALS (special education) students report using ATOD at levels slightly lower that the DADS (general education) students;

B. by the 10th grade, the special education students report using ATOD at higher rates in every category than their counterparts in general sample of students; and,

C. the pattern of usage observed for 10th grades continues into the 11th and 12th grades.

These preliminary results suggest that special education students, contrary to popular perception, are using ATOD at rates similar to or greater that the usage rates observed for their regular education peers.

As noted in the description of the project instrumentation, one item on the student assessment instrument asked the students whether they were exposed to ATOD activities or issues in their classrooms (Yes=1, No=O). The results of the Chi Square analyses comparing control and experiment students' responses to that item both at T1 and T3 are summarized in Table 3. Those results clearly indicate that students in the PALS group (although they started at roughly the same place at Time 1 as the students in the control group) felt that over the school year they were exposed to a significantly greater number of such activities and issues that did students in the control group. This finding documents that PALS teachers actually used the materials and activities covered during the training sessions in their classrooms, which is necessary if one expects to observe changes in students' attitudes and behaviors regarding ATOD use.

more aware students were of ATOD activities in their classrooms.

The results dealing with the effects of the pilot program on student's attitudes and behaviors were encouraging given the preliminary nature of the study, but did not reach the specified level of statistical significance Table 4. A review of those statistics shows that on all seven of the criteria the experimental students' performance at the end of the school year was higher or more positive than that of students in the control group. The results of the associated Mann-Whitney Test, however, indicate that overall these differences were not statistically significant. The two criteria that appear to have been impacted the most by participation in the PALS Program are the "Intend to Use ATOD in the Future?" (p=.08) and "Peer Pressure: ATOD Use" (p=.08) variables. Several potential explanations as to why these results may have occurred are discussed in the materials that follow.

Discussion

The result of the current pilot test indicate that the use of ATOD by special education students appears to start later than use by general education students. However, by the end of high school these students are using ATOD at a comparable, or in some cases higher, rate than their non-special education peers. In order to help reverse this trend, teachers in special education classrooms need to be familiar with and able to adapt prevention materials to meet the needs of their students. Teachers who received the PALS training felt more equipped to do this type of adaptation,and based on the results of this pilot study, appear to put what they have learned to use in their classrooms.

Although students in the experimental setting recognized the added emphasis their teachers were placing on ATOD-related prevention activities/materials and their attendant attitudes/behaviors as measured by the seven criteria described in Table 1 did improve somewhat, those improvements were not significantly greater than the changes in criterion attitudes and behaviors observed for the control subjects. One possible explanation for this findings, aside from limitations associated with the quasi-experimental nature of the overall design, is that the pilot test was undertaken over to short a period of time. For one thing, the teachers did not complete their training until November and the final testing of students occurred in April of the following spring. Also, the series of five specific lessons targeted for the experimental teachers/classes did not end until a couple of weeks prior to administration of the Time 3 survey- hardly adequate time for the teachers to integrate and effectively present the associated substantive content in their classes. On a somewhat more technical level, for a program of this nature, seven criteria may be too many outcomes to consider, especially given their short length, which means that they are likely to exhibit either "floor" or "ceiling" effects. In future test of the PALS programs these operational shortcomings need to be addressed and is more likely that documentation of the desired results will result.

Despite the shortfalls of the current pilot study mad its attendant results, there are two trends that make ATOD prevention education for special education students even more important in the future. The first is the very diverse makeup of the special education population, from developmental disability to physical disability to learning disability. Students who have different learning abilities need to have all aspects of their education, especially ATOD prevention education, adapted so that they can take advantage of it. The second trend is the increasing inclusion of special education students into mainstream classrooms. In most respects this is a positive move, but in terms of ATOD education, it may mean both fewer opportunities for special education students to have their specific needs met by the teachers and the potential for increased peer pressure to use at a younger age.

The current results also suggest that future research in the area should attempt to reach students at younger ages. Rather than starting ATOD prevention targeted toward students in high school, when use patterns may already be fixed, prevention initiatives should probably be targeted more toward teachers and students who attend middle and/or junior high schools. This recommendation is in keeping with research to date, which has shown that the longer a person puts off initially using alcohol or other drugs, the less likely that person is to become harmfully involved with such substances (Moore, Greer, & Li, 1994). Also, we know that youth with disabilities who use ATOD experience the associated negative legal, social, and medical consequences sooner than their peers without disabilities (Morgan et al, 1994). Finally, in the future, student surveys need to be strengthened and perhaps supplemented with other methods of assessing students' attitudes and knowledge about ATOD in order to capture subtle differences that may have been missed in the current study.

Table 1
Overview of Student-Related Criterion Outcomes Used in the
Study

Variable Name                   Number    Coefficient
                               of Items     Alpha

Ever used ATOD?                   5         .74

Used ATOD within last 30          7         .70
days?

Intend to use ATOD in the         8         .85
future?

Perception of harm from           6         .83
ATOD?

Peer pressure regarding           6         .71
ATOD use

Self-image and getting along      7         .58
with others

Portrayal of best friends'        5         .83
ATOD use

Variable Name                  Potential   Range:
                               Low Value    High
                                           Value

Ever used ATOD?                  5 (yes)     10(no)

Used ATOD within last 30         0 (never)   35 (every
days?                                           day)

Intend to use ATOD in the        0 (no)      13 (yes)
future?

Perception of harm from            1             13
ATOD?                          (negative)    (positive)

Peer pressure regarding          2 (low)     13 (high)
ATOD use

Self-image and getting along     7 (get      28 (do not
with others                      along)       get along

Portrayal of best friends'       5 (yes)      15 (no)
ATOD use

Table 2
Current ATOD Use Among Special and General Education High School
Students

Group     Grade            Prevalence   Rates:
          Level

                  % Using   % Using     % Using      % Using
                  Tobacco   Alcohol     Marijuana   Inhalants

PALS        9        30.9    33.8        13.2         4.4

DADS        9        30.1    38.2        22.2         8.9

PALS       10        47.9    49.3        32.4         5.6

DADS       10        33.9    42.7        23.4         4.6

PALS    11 & 12      50.0    53.3        46.6           0

DADS       12        39.0    50.8        25.1         2.0

Table 2
Current ATOD Use Among Special and General Education High
School Students

                           Prevalence    Rates:
Group    Grade
         Level   % Using   % Using       % Using     % Using
                 Tobacco   Alcohol      Marijuana   Inhalants

PALS       9      30.9      33.8          13.2        4.4
DADS       9      30.1      38.2          22.2        8.9
PALS      10      47.9      49.3          32.4        5.6
DADS      10      33.9      42.7          23.4        4.6
PALS     11&12    50.0      53.3          46.6          0
DADS      12      39.0      50.8          25.1        2.0

Table 3
Student Assessment of "Exposure to ATOD Activities in Their
Classes"

                       Groups

                       Experimental (PALS)

Dependent Variables        n      Mean       Stan.   n
                                             Dev.

Time 1-Awareness of       81       .54       .50     90
ATOD Activites in
Classes

Time 3 -Awareness of      66        .85      .36     75
ATOD Activities in
Classes

                       Groups

                       Control

Dependent Variables    Mean   Stan   [X.sup.2]-
                              Dev.     Value

Time 1-Awareness of    .46    .50      1.31
ATOD Activites in                    (p=.25)
Classes

Time 3 -Awareness of   .43    .50      26.6
ATOD Activities in                   (p=.00)
Classes

* Note that the scale was scored with a "Yes" response as "1" and a
"No" as "0", to the higher the mean the

Table 4
Comparisons of the PALS and Control Groups on 7 Time
AttitudinaFBehavioral Criteria

                                  Groups

                     Experimental (n=64)     Control (n=70)
Criteron               Mean   Start. Dev.   Mean   Stan. Dev.

Ever used ATOD?        8.22     1.44        7.96     1.58
Used ATOD within       2.98     4.04        3.84     4.16
last 30 days?
Intend to use ATOD     2.30     2.95        3.36     3.31
in the Future?
Perception of harm     2.78     2.25        2.89     2.13
from using ATOD
Peer pressure          4.70     2.29        5.61     2.52
regarding ATOD use
Self-image/getting     13.23    3.74        13.81    3.90
along with others
Portrayal of best      12.30    2.56        12.01    2.83
friends' ATOD use

                          Mann-Whimey
Criteron                 Test Results

Ever used ATOD?      Z=.64     (1>=.52)
Used ATOD within     Z=-1.24   (p=.22)
last 30 days?
Intend to use ATOD   Z=-1.75   (p=.08)
in the Future?
Perception of harm   Z=-.48    (p=.63)
from using ATOD
Peer pressure        Z=-1.72   (p=.08)
regarding ATOD use
Self-image/getting   Z=-.39    (p=.70)
along with others
Portrayal of best    Z=.23     (p=.82)
friends' ATOD use

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JACQUES DEMERS, MS, RN
DEANNE C. FRENCH, PH.D.
DENNIS MOORE, ED.D. SARDI
Wright State University School of Medicine, Dayton, Ohio