EXAMPLES OF EXPERIENCE WITH IMPLEMENTATION OF EXISTING PREVENTION PROGRAMS

In all fields of health, including the prevention of MEB disorders, there is a time lag between documentation that an intervention, program, policy, or practice improves health in a defined community and successful adoption of that program in society (Walker, Grimshaw, et al., 2003; Walker, Seeley, et al., 2008). Levels of implementation of preventive interventions are rarely measured; however, more information is available on implementation of substance abuse prevention in schools than on other prevention interventions. In a national study of middle schools, Ringwalt, Ennett, and colleagues (2002) found that, while 81.8 percent of public and private schools offered a substance abuse prevention curriculum, only 26.8 percent were using 1 of 10 tested and effective curricula. Furthermore, even when schools and communities use tested and effective programs, they often fail to implement them with fidelity to the standards delineated by program designers (Ennett, Ringwalt, et al., 2003; Mitchell, Florin, and Stevenson, 2002; Wandersman and Florin, 2003).

The National Study of Delinquency Prevention in Schools (Gottfredson and Gottfredson, 2002) found that only half of drug prevention curricula and one-fourth of mentoring programs met “dosage” requirements (amount of students’ exposure to the subject). The rest delivered fewer and less frequent sessions than were specified by program developers. Moreover, only half of the programs were taught in accordance with the recommended methods of instruction.

Hallfors and Godette (2002) report that only 19 percent of all surveyed school districts faithfully implemented tested and effective prevention curricula. Similarly, Ennett, Ringwalt, and colleagues (2003) found that only 14 percent of middle school teachers of drug prevention curricula exposed their students to adequate content and means of delivery. Yet adherence to core program components is important to ensure outcomes. There is evidence that some tested and effective prevention programs work only when implemented with a high degree of fidelity (Abbott, O’Donnell, et al., 1998; Botvin, Mihalic, and Grotpeter, 1998; Henggeler, Brondino, et al., 1997; Kam, Greenberg, and Wells, 2003; Olweus, Limber, and Mihalic, 1999). Methods for widespread dissemination of tested and effective prevention policies and programs with high levels of fidelity are needed (Farrington and Welsh, 2006; Spoth and Greenberg, 2005; Wandersman and Florin, 2003).

Often, federal or state guidelines dictate reimbursement only for using approved or evidence-based programs. For example, the tobacco settlement money from several states allows for funding of specifically named prevention programs. Colorado amended its revised statutes to provide continued



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