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Skills Training
A culturally adapted version of a widely established cognitive behavioral training program for youth.
Skills Training is a culturally tailored, school-based intervention to prevent substance use among youth. The program incorporates education, modeling, and rehearsal of cognitive behavioral skills delivered in 15 weekly sessions of 50 minutes each, plus semiannual booster sessions. Schools were randomly assigned to one of three conditions: intervention, intervention plus community-wide awareness-raising activities, and no intervention. Skills training included problem-solving, personal coping, and interpersonal communication, all incorporating culturally relevant material. The community component included activities to raise awareness of the study’s substance abuse prevention messages as well as meetings, flyers, and posters to inform the community about the intervention. Self-report data were collected at baseline, post-intervention, and every 12 months thereafter for 3 years.
Outcomes
Significantly lower use of alcohol, tobacco, and marijuana in the intervention condition alone, without the community awareness component.
Pretest alcohol use scores did not differ among the three conditions. At 30 and 42 months, self-reported alcohol use was significantly lower among those receiving the Skills intervention than among those in the control group. There were similarly significant longer-term differences between the Skills intervention and the control group for smokeless tobacco and marijuana use, but not for cigarette smoking. The community intervention did not add to the positive outcomes for the Skills training.
Costs
Medium costs due to intensity of intervention, staffing, training, and materials.
Assuming access to school infrastructure and teachers, there would be medium level of start-up and ongoing costs. School-based interventions require investment of time, training, resources, and possibly material costs. Staffing costs will vary dependent upon the background of group leaders and training needs, especially if booster sessions require hiring and training new staff. Costs to implement the community component would include additional expenditure for activities and media messages.
Cultural Engagment
All intervention sessions included pan-Indian cultural content.
The intervention was tailored for Native youth, and every intervention session included Native American values, legends, and stories. Given the variation of Tribes and groups represented in the sample, the components were not Tribally specific, but rather celebrated traditions and beliefs endorsed across many Tribal and regional groups. Input from the Tribal or local community leaders was not described.
Participants
Child; Native; Female, Male
Setting
Community Wide, Reservation, School
Delivery
Medium Group, Multi-level, Face-to-Face
Young children received intervention in reservation elementary schools.
Native students (n = 1,396) in 3rd, 4th, and 5th grades were recruited from 10 reservations. The sample was 49% female, and the mean age was 10.3 years. Intervention lessons were delivered to Native elementary schoolchildren in 27 Tribal and public schools. The community engagement component included community members (families, teachers, law enforcement) who were encouraged to support substance abuse prevention.
Staffing Needs
Not Specified
Staffing needs were not specified.
The background and credentials of group leaders were not specified. Slightly older peers demonstrated skills.
Research Design
Randomized controlled experimental design
Developmental stage of research
This cultural adaptation of an established intervention adds to the rigorous body of research on this prevention program.
Skills Training is a promising intervention when delivered alone, without the community component. Strong research design, large sample size, excellent retention rates, and fidelity checks lend confidence to the intervention effects reported.
Potential
Inclusion of pan-Indian cultural components is promising but needs more intervention specifics in order to widely implement.
The intervention was tailored at a pan-Indian level which supports transportability to other Indian communities. However, without more information about staffing, resources, and logistics, it is hard to assess the feasibility of implementation elsewhere.
References
Schinke SP, Tepavac L, Cole KC. Preventing substance use among Native American youth: Three-year results. Addict Behav. 2000;25(3):387-397. https://pubmed.ncbi.nlm.nih.gov/10890292. https://doi.org/10.1016/s0306-4603(99)00071-4.
Schinke SP, Botvin GJ, Trimble JE, Orlandi MA, Gilchrist LD, Locklear VS. Preventing substance abuse among American-Indian adolescents: A bicultural competence skills approach. J Couns Psychol. 1988;35(1):87-90. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1838568. https://doi.org/10.1037/0022-0167.35.1.87.
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