• By Kevin Mount
  • Posted on Monday 26th November, 2007

Untangling program design the Tanglewood way

When evaluators of prevention programs try to answer the question, ‘What works?’ they will often give surprisingly short shrift to the ‘what’ part of their enquiry. Read almost any journal article about an intervention, and you'll find a great deal of attention given to assessing outcomes – participants were better behaved, more sober and the like – but much less to how the program accomplished those results. Indeed, a fairly standard approach is to devote one or two short paragraphs to describing what went on, perhaps making passing mention of the broader theories on which an intervention was based. The implication is that theory is to be regarded as purely an academic concern – a topic on which a readership of social workers, teachers, therapists, and other practitioners need not waste very much time. William Hansen and his colleagues at Tanglewood Research, North Carolina question this assumption. A theory provides an explanation of why a program works. For example, if a theory proposes that kids use drugs for social acceptance, then an effective intervention might work to provide kids with other ways of feeling accepted and admired by their peers. If evaluations of real-world programs tend to support some theories over others, then policymakers and practitioners know better what types of program are worthy of investment. The problem here is that most prevention programs – those designed to prevent substance abuse, for instance – will draw on an amalgamation of theories. And this state of affairs leaves the reader of a typical journal article with only a vague understanding of why the designers of the program thought it might work or whether programs with similar components might also be successful. To start to clean up this messy theoretical landscape, Hansen and his colleagues examined substance abuse prevention programs listed on the National Registry of Evidence-based Programs and Practices, a database managed by the US Substance Abuse and Mental Health Services Administration . The Registry lists programs judged by experts to be successful and to have well-documented effects. Tanglewood found 48 that had manuals that described how the programs work, and from studying the contents they concluded that the programs generally adopted one or more of these basic approaches:

  • changing an individual's motivation or disposition to use substances
  • promoting the development of personal competence (such as academic or decision-making skills)
  • developing interpersonal or social skills
  • changing social and environmental characteristics.
Approaches that aimed to reform individuals (eg. addressing beliefs about consequences, teaching decision-making skills and dealing with attitudes) were more common than those that aimed to change the environments in which young people spend much of their time (eg. providing opportunities for associating with positive peers or providing positive alternatives to drinking or using drugs).Hansen’s team hopes their organization of the substance abuse prevention landscape will encourage program evaluators to focus on the essential, active ingredients of effective interventions. For example, if a program aims to foster both decision-making skills and positive alternatives to drinking, an evaluator should consider the unique effects of each component and, by doing so, provide further evidence about which theories on why kids abuse substances are correct.• Summary of “Substance abuse prevention program content: systematizing the classification of what programs target for change” by William B. Hansen, Linda Dusenbury, Dana Bishop, and James H. Derzon in Health Education Research, 2007, Volume 22, Number 3, pp351-360.

Back to Archives