• By Kevin Mount
  • Posted on Wednesday 10th June, 2009

When program similarities count for more than differences

In the case of some of the more prevalent and troublesome developmental problems – drug abuse or conduct disorder, for example, – numerous programs have been invented over the years to address much the same issues. At first glance, they may look quite different, in terms of whether they are delivered in school or at home, to children alone or with their parents. They may even reflect contrary views of the causes. However, as researchers from Wake Forest University and University of California explain in the journal Prevention Science, there are likely to be underlying similarities. Uncovering the common threads might be the key to developing more versatile interventions. Elizabeth Arnold and Mary Jane Rotheram-Borus examined six evidence-based HIV prevention programs for homeless young people, all of which have been widely disseminated in the US. They classified them according to whether they were delivered individually to the young person, with the family or in a group, and in terms of location and duration and the training practitioners received.They also examined how each program theorized the causes of homelessness and HIV and presented the rationale behind the solution they were offering. Some obvious differences were identified. For example, Adolescent Community Reinforcement Approach (A-CRA) saw drug abuse as the main risk for contracting HIV. Homeless young people resorted repeatedly to drugs, the designers argued, because their behavior was somehow reinforced by family, friends or employers. Drawing on social cognitive theory, A-CRA was aiming to break this cycle by encouraging pro-social behavior incompatible with drug use. It was delivered to young people and their parents together.Street Smart, on the other hand was based on 12 group work sessions inside homeless shelters. It taught skills and coping mechanisms that might curb risky behavior – such as drug abuse or unprotected sex – that increased vulnerability to HIV. It also helped young people to obtain health care. Despite these and more differences between the six programs, the researchers identified three unifying strands. All were trying to provide young people with a continuous safety net; the difference was in how they set about providing it. There was also agreement that young people required support for their overall developmental needs. Hence, all of the interventions were designed as additions, not replacements for existing services. In order to engage young people and their families, which was often half the battle with this type of intervention, all six programs avoided assigning blame or dredging up the past. When developing future HIV prevention programs for homeless young people all of these elements should be in place, the authors recommend. Arnold and Rotheram-Borus also conclude that the demands of dissemination of programs on a wider scale must be taken into account at the experimental stage.“It is critically important to create programs that can be feasibly and broadly disseminated, immediately after the program’s efficacy is demonstrated,” they report. They recommend that for HIV prevention programs to be truly effective, they must adhere to a theoretical model to aid evaluation and be able to identify a viable funding stream. The ultimate destination of programs at scale should also be considered. They point out that to make a dent in the global AIDS epidemic, it must be practicable to roll out programs in Africa, home to 65% of those living with the disease. Four of the six proven programs they examined fell short because they depended on practitioners being trained to Masters level – a resource sadly not available in the developing world. See: Arnold E M and Rotheram-Borus M J (2009), “Comparisons of Prevention Programs for Homeless Youth” Prevention Science, 10, pp 76-86

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