Process Communications Model

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School-based interventions to reduce drug/alcohol
use Evidence-based practice in the trenches
www.pv-psg.org 316-284-6446
regierng_at_pvi.org
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Who is Prairie View?

• Non-profit Community Mental Health Center
• Open since 1954
• 450 employees, serves 12,000 patients/year
• Full range of services, including inpatient
  hospital, outpatient therapy, school for at-risk
  youth, adolescent residential program,
  community-based outreach, housing
• 15 years of clinical outcomes research
• 14 years of adventure-based programming with
  inpatient, outpatient, and non-clinical
  populations of all ages
• 6 years of outcomes research in adventure
• Partnering with Project Adventure to study
  outcomes tools, provide open enrollment
  trainings, and study behavioral management
  models.

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Who is Process Solutions?

• Prairie Views organizational consulting,
  training, and research division
• Vision statement Renewing Spirit, Discovering
  Strengths, Pursuing Excellence
• Three core components
• Process Communication Model (PCM)
• Adventure-based learning models
• Self-Efficacy outcomes measurement

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Overview

• Setting the stage
• Getting the contract making the case,
  connecting the dots
• Research design and data collection
• Results so far
• Lessons learned
• Discussion

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Prior experience

• Worked with Haysville Alternative school during
  2005-2006 school years experimenting with
  combination of adventure course and school-based
  adventure groups.
• Collected outcomes data with control groups
  showing effectiveness in raising self-efficacy
• Had begun capacity building with alternative
  school staff to conduct school-based groups

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The big one!

• Haysville school district taking bids on
  drug-alcohol reduction programs
• Already had a liking for adventure-based methods
• Strong school board pressure for hard-line
  fear-based tactics such as drug dogs
• School advisory council allowed us to make a
  presentation, submit a bid

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Making our case

• Escalating drug and alcohol use, along with the
  negative health and societal consequences
• Increasing communication gap between youth and
  adult culture
• Changes in socio-economic profile and gaps
• Increasingly fragmented family and community
  support systems
• More and more responsibility shifted to schools
  to help deal with the problems
• So many things interfering with the learning
  process

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Our hope

• Reducing drug and alcohol use/abuse among youth
• Making school a place where youth are developing
  the skills necessary to become healthy,
  contributing adults
• Feeling like we are really connecting with kids,
  making a difference in their lives
• Modeling effective approaches, where others can
  come to observe and learn

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Wheres the problem? Wheres the solution?

• Attitudes, values, and beliefs about student drug
  and alcohol use
• From your perspective, whats the solution to all
  this nonsense?

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How did you answer?

• Nurturing ___
• Values ___
• Information ___
• Fun ___
• Direction ___
• Excitement ___

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Source Pauley, Bradley Pauley (2003). Heres
How to Reach Me. Brooks Publishing
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Less than 20 of the youth account for more than
80 of the problems
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Toward No Drug Abuse (TND)

• SAMHSA Model program status
• Lists individual, family, school, and community
  protective factors
• 1/3 of the factors relate to having adequate
  information
• The remaining 2/3 relate to developing social and
  emotional intelligence

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CTC Survey Data for Haysville

• Drug/Alcohol use above county and state averages
  on most indicators
• Below averages on protective factors
• Above averages on risk factors
• Getting bad press
• Of the 17 peer/individual, family, and school
  risk factors, 14 relate to social/emotional
  intelligence process factors, i.e. patterns of
  getting motivational needs met in unhealthy ways,
  failure to engage or relate effectively, or
  mismatch between environmental demands and coping
  skills

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So what are the keys?

• Self-awareness - understanding what makes me tick
  and stop ticking effectively
• Responsibility - Skill-building in meeting my
  needs in healthy ways, recognizing and reversing
  negative attention patterns
• Belief in my ability to act on what I know and
  learn
• Hope that my effort will get me somewhere
• Support - peer, school, family, and community
  support for positive change

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Self-Efficacy

• A persons belief in their ability to act in a
  manner appropriate and necessary to deal with
  various situations (Bandura)
• Social/Emotional skills in action
• The difference between what you know, and what
  you do with what you know.
• With regard to its impact on health and
  wellness, positive behavior change, and
  overcoming obstacles, self-efficacy is the most
  well-researched and strongly supported construct
  currently available.

For a glimpse into the world of self-efficacy, go
to www.des.emory.edu/mfp/self-efficacy.html
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Self-Efficacy

• Differs from attitudes, values and beliefs about
  others or situations self-efficacy is focused
  on personal capabilities.
• Transcends age, gender, type of problem, or
  socioeconomic status.
• Self-efficacy is necessary for a person to act on
  what they know or learn.
• It connects a persons innate gifts, resources
  and potential with the demands of the real world
• Is NOT self-esteem (see work by Roy Baumeister)
• Strongly connected to failing forward and
  resilience

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Process Solutions knows what works

• Prairie View has a 52 year history in building
  self-efficacy. We are in the change business.
• 14 year history in measuring outcomes in mental
  health and substance abuse treatment exploring
  the most effective approaches.
• Just received Lattner Foundation grant to advance
  our work in outcomes
• 13 year history in adventure-based programming
• Present nationally at conferences
• Published outcomes tools
• Partnership with Project Adventure, the nations
  premier adventure training and programming
  organization
• Ongoing calendar of training programs
• Ongoing research programs
• Proven results with local schools

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Programs are effective when they

• Understand the impact of personality on behavior,
  engagement, learning, and motivation
• Involve models of personality that go deep enough
  in explaining distress, negative attention, and
  many of the dynamics influencing drug/alcohol use
• Place emphasis both on providing information AND
  building self-efficacy
• Focus on potential and resiliency instead of
  whats wrong with youth (i.e. strengths-based)
• Focus on empowering youth to make positive
  changes rather than trying to control behavior
• Include effective capacity-building for staff
• Provide tools for culture change within systems

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Our tools

• Perceived Competence of Functioning Inventory
  (PCFI) 16 item self-report assessment of
  self-efficacy
• Motivational competencies - setting and pursuing
  goals
• Affective competencies dealing with feelings
  about self
• Cognitive competencies judgment and critical
  thinking
• Relational competencies - connecting with
  others, giving and receiving support
• General Level of Functioning overall efficacy
• Internal consistency of .88 - .90
• Test-retest reliability - .73
• Validated against the MCMI, Hope Scale, Ways of
  Coping Scale, Brief Symptom Index, and OQ-45
• Preliminary data from a large-scale
  longitudinal study at University of Minnesota on
  the impact of adventure-based interventions on
  drug/alcohol use shows that raising motivational
  and relational competencies are the two strongest
  predictors of success.

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Our tools

• PCFI 8-item scale for ages 10-13
• Same subscales as PCFI-16
• psychometrics not established yet

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Our tools

• Process Communication Model (PCM)
• Transactional personality communication model
• Defines 6 personality types, each with specific
  and predictable
• Perceptual filters and preferred channels of
  communication
• Character strengths
• Psychological needs and motivators
• Learning styles and environmental preferences
• Second by second negative attention and sabotage
  behaviors
• Likely racket emotions /authentic unresolved
  emotions
• Typical clinical manifestations
• Manual, training trajectory, and competency
  skills verification exists, so fidelity easier to
  manage

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Experiential/Adventure Learning

• Learning through doing
• Clearly superior to sit n git learning
  enhances retention and application of material
• Engages multiple learning and personality styles
• When done well, closely mimics real-life social
  and emotional challenges
• Proven to positively impact key areas of
  self-efficacy
• Published meta analysis proves effectiveness
• Our data from 800 students completing similar
  programs over the last 3 years replicates these
  findings

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Our success with youth

• Analysis of 800 youth participating in our
  adventure course programs show statistically
  significant gains in self-efficacy with moderate
  to large effect sizes.
• Numerous individual examples of transformed
  lives.
• No comparison groups or follow-up data yet.

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Our success with at-risk youth Grades 6-12

• Analysis of 204 at-risk students from 5 different
  schools (including Haysville Alternative) who
  have completed our school-based programs since
  2005, and 23 matched controls.
• Slight reduction in motivational, affective,
  cognitive, and relational capabilities for
  control group
• Significant improvements in all scales for
  treatment group
• When asked to rate their confidence in coping
  without using drugs or alcohol negligible
  change in control group, improvement in treatment
  group. Although the improvement was fairly
  small, it was 15 x larger than the change in the
  control group.
• Our programs reversed a negative trend without
  changing curriculum or staffing. When we train
  staff and parents to use these tools, outcomes
  can be even more dramatic.

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Why choose Process Solutions?

• Local relationships and support that will be here
  for the long term
• Clinical expertise and history
• Proven tools, proven outcomes
• Research experience and national partnerships for
  excellence
• Shared values

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What do you have to gain?

• Impact on target behaviors, enhanced student
  efficacy and achievement, enhanced staff morale
• Publicity and recognition for innovation
• Opportunity and research data to obtain grant
  funding

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Implementation Planstart small, demonstrate
results, get funding to expand

• Level 1 Direct services for at-risk youth
• Level 2 Capacity building for staff
• Level 3 Consultation/Coaching
• Level 4 Advanced training to build local leaders

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Level 1 Direct Services

• LEEP program Learning and Empowerment through
  Experiential Programs
• Up to 15 students
• 1 hour/week on-site groups for 6 weeks
• Finish with 1 day on adventure course
• Outcomes tracking for treatment and matched
  control group
• Fidelity
• Program manual
• Weekly facilitator consultation group
• Dual facilitator model

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Level 2 Capacity Building

• 2 day PCM training (second semester)
• Content
• Teach teachers the PCM model, which outlines
  basic skills in connecting, motivating, and
  reducing conflict in the classroom for all 6
  personality types
• Teach tools for empowering students to get their
  psychological needs and motivators met in
  healthy, productive ways (rather than with
  drugs/alcohol/violence)
• Teach basics of transforming the classroom into
  an environment that supports all learning styles
  and engages all students
• Could be applied for parents as well (perhaps
  even include parents?)
• Fidelity
• Manual and rigorous certification training
• Regular group consultation among trainers
• Dual trainer model

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Level 3 Consultation/Coaching

• PVPS staff on-site for regular consultation and
  coaching
• 1 hour ten times during semester

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Level 4 Advanced Training

• For selected staff/students who will be mentors
  and consultants to rest of the system
• Students selected/apply from LEEP program
• 3-days customized training in using PCM and
  adventure based methods in the school to
• enhance impact of programs such as Challenge Day
  or other adventure-based programs, every day
  throughout the year.
• meet diverse student needs
• increase self-efficacy
• break down barriers and stereotypes
• build peer accountability culture

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Funding Options

• Funds that directly relate to these services
• Safe and Drug Free Schools dollars
• Staff Development funds
• At Risk Student funds
• Other options?

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Anticipating resistance
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Yes, but.

• Not many people will receive your services. How
  can that really make a difference?
• At risk youth can lead the gangs, or they can
  lead the healthy initiatives. Connect with them
  first.
• Its not about Prairie View connecting with each
  person. Its about initiating a culture change,
  moving toward a tipping point, empowering the
  right people to spread positive energy, finding
  and developing leaders, and gaining momentum.
• Capacity building recognizes that those who deal
  with the kids, families, and community day in and
  day out are the ones who can really make a
  difference.

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Yes, but.

• What about the kids who are already using?
• You cant stop them, but you can begin to create
  a culture and environment that is incompatible
  with drug/alcohol abuse
• This is a long-term investment

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Yes, but.

• When will we fit this all in?
• How are at risk youth spending their time now?
  How productive is it? What are they
  accomplishing?
• How much time are staff spending dealing with the
  distraction of disengaged youth, consequences of
  drug/alcohol use and other problems we are
  attempting to address?
• The intended result is that everyone involved
  (staff and students) are making more productive
  use of their precious time.

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Yes, but.

• What about the schools who arent involvedwhat
  can they do?
• Assist in efforts to find funding
• Work to develop community coalitions and
  partnerships
• Volunteer to be a control group
• Send one or two staff to our open enrollment
  seminars to test-drive what we do
• Initial demonstration training should include
  staff from around the district so we can discuss
  this question during those two days
• Promote the program and listen to what others are
  learning

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Obtaining Collaboration

• Built on existing relationship with the
  districts education coordinator and principle
  from one of the grade schools
• Proposal presented to district site council
• Follow-up presentations and planning meetings
  with principles and counselors from the two
  participating schools

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Research Design

• Crossover design. Conditions crossed over at
  Spring semester
• New elementary school - 5th graders 2 classes
  (N 27) experimental group, 2 classes (N 28)
  control group
• H.S. Access Program for students designated as
  at risk based on grades and other behavioral
  indicators
• 49 students Randomly assigned to experimental and
  control groups

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Data Collection Protocol

• PCFI at week 1, 4, and 6 of LEEP, day before and
  day after Adventure course, and semester end.
• Control group Week 1, 4, 6, and semester end
• Behavioral data collected for prior year (2006)
  and current year to date.
• GPA
• Math and Reading test scores
• Attendance (h.s. only)
• Behavioral referrals (h.s. only)
• Attendance (h.s. only)

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Challenges along the way

• Getting all the PCFI data collected
• Designated internal staff person trained to
  collect all PCFI data for every condition
• All PCFIs were completed in classroom setting,
  same time of day (even for adventure course)
• PVPS facilitators brought data back to our lab
  for scoring
• Our outcomes coordinator had constant contact
  with school to update on status of data
  collection, missing data, etc.

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Challenges along the way

• Changing plans mid-stream
• H.S. staff didnt show up for consultation,
  didnt support LEEP program
• Resources and funds diverted to elementary school
  for second semester

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Challenges along the way

• Gathering behavioral data
• Took several months for school to collect and
  deliver all the data
• Lots of missing data, no referral or attendance
  data for elementary students
• Lots of passing the buck

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What weve got so far!

• Psychometrics of the PCFI
• PCFI self-efficacy data for program and control
  groups
• Associated behavioral data for program and
  control groups

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Testing Internal Consistency

• 49 high school students completed PCFI-16 at 4
  time frames throughout semester. Program group
  (N 25) also completed PCFI before and after day
  on adventure course
• 55 5th grader students completed PCFI-8 at 4 time
  frames throughout semester. Program group (N
  28) also completed PCFI before and after day on
  adventure course

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Implications

• Reliability goes up with repeated administrations
  (would be expected) but stabilizes somewhat over
  time
• As with our previous experience, initial
  administration with a group is less reliable than
  follow-up administrations (demand
  characteristics, lack of trust, etc.)
• 8-item PCFI performed respectably, may present a
  viable alternative for younger children
• Examining test-retest reliability, and subscale
  characteristics are the next steps

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Prairie Elementary PCFI Results
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Prairie Elementary PCFI Results
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Prairie Elementary PCFI Results
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Prairie Elementary PCFI Results
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Prairie Elementary PCFI Results
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Behavioral Measures Prairie Elementary
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Prairie Elementary SummaryProgram Vs. Control
Summary

• PCFI
• No difference between groups on any scales at
  beginning
• Motivational scale significantly higher at end
  for program group
• Cognitive scale approaching significance at end
  for program group
• GPA Change Scores
• N.S. difference between groups
• Math Change Scores
• N.S. difference between groups
• Reading Change Scores
• Control group started higher and made
  significantly more change than program group

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Campus High School PCFI Results
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Campus High School PCFI Results
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Campus High School PCFI Results
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Campus High School PCFI Results
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Campus High School PCFI Results
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Behavioral Measures Campus H.S.
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H.S. At risk youth SummaryProgram Vs. Control
Summary

• PCFI
• Groups did not differ significantly at the
  beginning on any scales
• Groups did not differ significantly at the end on
  any scales
• GPA Change Scores
• N.S. difference at beginning or end of semester
• Math Change Scores
• N.S. difference at beginning or end of semester
• Reading Change Scores
• Control group started higher and made
  significantly more change than program group

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Teacher Capacity building
Day on the adventure course
Two-day course on student communication and
motivation
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Alternative H.S. Students

• School-based groups running autonomously using
  school staff
• Each semester the group comes to the adventure
  course.

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Good news / Bad news

• Prairie Elementary has invested fully, is moving
  forward with teacher capacity building and
  culture shifts.
• Campus high school still teetering, trying to
  decide what to do wants us to treat the problem
  kids, little ownership for culture change.
• Alternative high school continues to use the
  adventure course, and rely on us for
  consultation, and achieving great results.
• Comparing these three schools, seems that it pays
  to commit over time, invest in internal capacity,
  and integrate adventure more fully into the
  educational climate.

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Next Steps

• Finish out school year, see what second semester
  data after crossover looks like.
• Definitely increase intensity of school-based
  interventions in both schools.
• Continue to track behavioral and PCFI data over
  the next 12-18 months.
• Stick with protocol as best we can.
• Explore ways to increase motivational and
  relational scales more.
• Continue tracking CTC data
• Explore gender differences as well as the
  psychometrics of PCFI-8
• Examine fidelity of implementation better