prevention counseling and student assistance programs: a review of the literature

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Prevention Counseling and StudentAssistance Programs: A Review of theLiteratureBarry Loneck a , Matthew J. Corrigan b , Lynn Videka c , Lucy J.Newman d , John Charles Reed e & Kimberly E. Moonan fa University at Albany, State University of New York , Albany, NY, USAb Long Island University-Brooklyn Campus , Brooklyn, NY, USAc New York University , New York, NY, USAd Evidence-Based Practice in Mental Health Project, New York StateOffice of Mental Health, Adult Services Division , Albany, NY, USAe Shaw University , Raleigh, NC, USAf Columbia University , New York, NY, USAPublished online: 19 Aug 2010.

To cite this article: Barry Loneck , Matthew J. Corrigan , Lynn Videka , Lucy J. Newman , JohnCharles Reed & Kimberly E. Moonan (2010) Prevention Counseling and Student Assistance Programs:A Review of the Literature, Journal of Child & Adolescent Substance Abuse, 19:4, 279-299, DOI:10.1080/1067828X.2010.488976

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Prevention Counseling and StudentAssistance Programs: A Review

of the Literature

BARRY LONECKUniversity at Albany, State University of New York, Albany, NY, USA

MATTHEW J. CORRIGANLong Island University-Brooklyn Campus, Brooklyn, NY, USA

LYNN VIDEKANew York University, New York, NY, USA

LUCY J. NEWMANEvidence-Based Practice in Mental Health Project, New York State Office of Mental Health,

Adult Services Division, Albany, NY, USA

JOHN CHARLES REEDShaw University, Raleigh, NC, USA

KIMBERLY E. MOONANColumbia University, New York, NY, USA

Substance abuse prevention counseling can be found in two venues:school counseling and student assistance programs (SAPs). Schoolprevention counseling is based on school psychology and guidancecounseling. The authors of this article did not find any empiricalstudies of prevention counseling. Six criteria were used to assessthe published research on SAPs: research designs, sampling methods,measures, procedures, analyses, and peer review of results. SAPstudies reviewed were placed in one of three levels: Rigorous(N¼ 3; met all inclusion criteria), Informative (N¼ 2; met allcriteria except peer review), and Evaluative (N¼ 5; weak design,but explicit in describing methods). The Rigorous Studies found adecrease in substance use or risk factors. The two Informative Studies

Address correspondence to Barry Loneck, PhD, LMSW, Associate Professor, TheUniversity at Albany, State University of New York, School of Social Welfare, 135 WesternAvenue, Albany, NY 12222, USA. E-mail: [email protected]

Journal of Child & Adolescent Substance Abuse, 19:279–299, 2010Copyright # Taylor & Francis Group, LLCISSN: 1067-828X print=1547-0652 onlineDOI: 10.1080/1067828X.2010.488976

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found a decrease in substance use. The Evaluative Studies demon-strated the prevention of increases in substance use.

KEYWORDS adolescent, prevention, prevention counseling,student assistance programs, substance abuse

INTRODUCTION

Recent surveys of drug use among American youths indicate that 81% ofAmerican high school seniors report use of alcohol and 54% report the useof illicit drugs before graduating from high school (National Institute of DrugAbuse [NIDA], 2003). Parents, educators, and human service providers havebeen alarmed by the high rate of drug use among youths. Constituenciesconcerned about the prevalence of drug use among youths have successfullyturned the attention of American substance abuse policy to the goal ofpreventing this high rate of substance use among youths.

The majority of attention regarding the efficacy of various preventionapproaches has focused on classroom curriculum-based approaches inschools for substance abuse prevention (NIDA, 2003). However, in severalstates, including New York, New Jersey, Pennsylvania, California, Washington,andOklahoma, considerable school-based substance abuse prevention invest-ment is delivered through group, individual, and family counseling. However,there has been less research on counseling approaches to school-basedsubstance abuse prevention as compared to curriculum-based approaches.This article reviews what is known about prevention counseling as a tool forsubstance abuse prevention in schools.

This review of the literature was commissioned by the New York StateOffice of Substance Abuse Services as part of a study of substance abuseprevention counseling in New York State. Its purpose is to review the stateof the art of knowledge regarding school-based substance abuse preventioncounseling and to determine to what extent this approach is supported byempirical evidence and conceptually consistent with the prevailing concep-tual model for understanding substance abuse prevention in youths. A histori-cal overview of counseling approaches provides a context for understandingthe role and style of prevention counseling in schools today. Following adetailed presentation of our findings, the article concludes with a discussionof the key elements of prevention counseling, a summary of the research find-ings on the effectiveness of prevention counseling, a critique of the researchmethods used, and next steps for additional research.

METHODS

We identified references for the review of literature on prevention counselingin four stages. First, we searched eight scholarly databases for relevant

280 B. Loneck et al.

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books, chapters, articles, and reports. Search terms used were ‘‘preventioncounseling’’ and ‘‘student assistance program.’’ Abstracts of identified sourceswere reviewed for relevance and to make an initial assessment of documentquality. In addition to the database searches, the tables of contents of 15journals relevant to prevention counseling were reviewed; this reviewspanned from 1996 to present in order to identify the most recent work inthe area. Following the tables of contents review, we examined bibliogra-phies from references obtained through the first two steps for additionalsources. Relevant materials were obtained from the SUNY-Albany librarysystem, from online sources, and through interlibrary loan. Full-text refer-ences were assessed for relevance and quality. Finally, references werereviewed for content in order to fully describe and evaluate substance abuseprevention counseling.

RESULTS

The literature review revealed that substance abuse prevention counselingcould be found in two different venues: school counseling and student assist-ance programs (SAPs). Before presenting the empirical research findings forthese two programs, it is necessary to describe the key elements of substanceabuse prevention counseling as found in the literature.

Substance Abuse Prevention Counseling in School Counseling

School counseling developed as an educational specialty after World War II.Prevention counseling, guidance counseling, and special educational servicesare all aspects of school counseling. The history of prevention counseling liesin the hybrid history of school psychology and guidance counseling; itsconcept is tied to a youth development orientation in school settings(Albee, 1995; Conyne, 1997; Keys, 2000; Kleist & White, 1997; Newnes,1990; Wagner, 1994).

The Rogerian therapeutic principles of empathy, non-directiveness, andself-discovery shaped the field of school counseling services (Kleist & White,1997). The philosophical roots of prevention counseling lie in this nondirec-tive approach to school counseling (Sandoval, 1988). Subsequent influenceson prevention counseling include therapeutic process research on adults, inthe tradition of the Rogerian school of thought, and the public health modelof prevention as developed by the early mental health preventionists such asGerald Kaplan (1961). Given its roots in guidance counseling and schoolpsychology, prevention counseling’s nondirective humanistic approach iscompatible with the culture of traditional school settings.

More recently, prevention counseling within school counseling intro-duced curricula along with counseling, targeting students and their families

Prevention Counseling and Student Assistance Programs Literature Review 281

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(Berdiansky, Brownlee, & Joy, 1989). The newest literature on preventioncounseling in this venue suggests role expansion for prevention counselorstoward more school-systems-based interventions informed by systemsand ecological theory (Albee, 1995; Baharoglu, 1989; Calhoun, Glaser, &Bartolomucci, 2001), and toward consultation with non-counseling schoolpersonnel as well as direct therapeutic intervention models (Keys, Bemak,Carpenter, & King-Sears, 1998).

Much of the prevention counseling literature within school counselingviews prevention broadly and addresses many youth problems, sometimesincluding substance use, sometimes not (Dryfoos, 1994; Sandoval, 1988).However, when reviewing the school counseling literature, two findingswere apparent. First, a focus on the current risk and protective factor modelof adolescent substance use and abuse is absent from these counseling meth-ods. Second, specific models for unique problems or behaviors targeted forprevention are not typically provided. Thus prevention counseling withinschool counseling lacks the risk and protective factor framework with whichto assess students and lacks specific models with which to intervene.

Substance Abuse Prevention Counseling in Student AssistancePrograms

The student assistance program (SAP) is a dominant approach in thesubstance abuse prevention counseling field. The major SAP member organi-zation is the National Student Assistance Association (NSAA). Lee Rush (2002,personal communication), former Executive Director of the organization, sta-ted it has 700 members from approximately 30 states and it has 18 state chap-ters. He estimated that more than 5,000 SAPs exist in the United States.

Two models of SAPs were identified in the literature review: the coreteam model and the counselor model (Klitzner, Fisher, Stewart, & Gilbert,1992; Milgram, 1989; Pollard & Houle, 1993). In its traditional form, the coreteam model is comprised of school personnel. The core team’s primarypurpose is to identify and assess problems and refer and provide follow-upservices to students who are involved in or at risk of involvement insubstance use or abuse.

In the traditional counselor model, schools contract with an outsidesubstance abuse agency for placement of a student assistance counselorwithin the school. The primary functions within the counselor model areto identify and assess problems, intervene or refer for services, and providefollow-up services. In an alternate form of the counselor model, school dis-tricts hire SAP personnel directly and they become part of the school staff(Borris, 1988; Rubinstein, 1991). Because the core team model typicallyexcludes interventions, this section focuses on the counselor model of SAP.

The following information describes the key elements of the counselormodel when used for substance abuse prevention within school settings.


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This description includes the referral process, staff qualifications, andprogram activities (assessment, contracting, intervention, and evaluation).

REFERRAL SOURCES

Referrals to the counselor model come from a wide range of individualsincluding parents, administrators, faculty, or any other concerned party(National Institute on Alcohol Abuse and Alcoholism [NIAAA], 1984).Students can also be self-referred, referred by school personnel, or mandatedfor service because of alcohol or drug use (Klitzner et al., 1992).

STAFF QUALIFICATIONS

Within the counselor model, staff size is minimal yet highly educated, experi-enced, and trained. Responsibility for the program rests on the student assist-ance counselor. Counselors must have a master’s degree in psychology,counseling, or social work, at least two years post-master’s experienceworking with adolescents, and three to four weeks of intensive training(Morehouse & Tobler, 2000a, b; NIAAA, 1983, 1984). The only notable excep-tion to these guidelines was one described in a study by Koll (1988) in whichthe counselor had only a bachelor’s degree.

PROGRAM ACTIVITIES

The counselor model makes use of the problem-solving model because itsstages are explicit throughout the SAP literature. While definitions varyamong authors (for general definitions of the problem-solving model seeD’Zurilla & Nezu, 1999; Hepworth, Rooney, & Larsen, 2002; Turner & Jaco,1996), the problem-solving model can be operationally defined by four majorstages: assessment, contracting, intervention, and evaluation. Each isdescribed in detail below. The forms include assessment, goals, and tasks(i.e., recommended activities), interventions (albeit only by modality), anda post-intervention evaluation.

1. Assessment. Assessment has been increasingly influenced by the risk andprotective factor framework. Initially, the counselor model targeted stu-dents in one or more of the following three categories: (1) those abusingalcohol or drugs; (2) those with parents who abused alcohol or drugs; or(3) those with behavioral or academic problems or those who werestressed, indicating a possible alcohol or drug problem of a parent orthemselves (Koll, 1988; NIAAA, 1983, 1984). However, as the substanceabuse prevention field became cognizant of risk factors associated withthe initiation of substance use and the development of substance abuse(Hawkins, Catalano, & Miller, 1992), SAPs expanded their reach to include


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students considered at substantial risk. These students included ones withhistories of child maltreatment or other family dysfunction; suicidalideation, gestures, or attempts; teen pregnancy; and school behaviorproblems. Examples include SAPs studied by Donovan and Wasco(1994) and Morehouse and Tobler (2000a). Given the known linkbetween risk and protective factors with adolescent substance use andabuse, coupled with the fact that substance abuse prevention counselingis used as a selected and indicated intervention, it is important thatstudents are served appropriately. When problems are considered severe,students are referred to services in the community, such as treatment(Morehouse & Tobler, 2000a; NIAAA, 1984).

2. Contract. The contract specifies the goals and tasks of subsequentinterventions. In its most basic form, students are asked to make a verbalagreement to a goal. Examples of goals may be to not drink alcohol, to notuse drugs, to improve relationships with parents and peers, to improveschool performance, and to decrease absences (NIAAA, 1984). Contractsrange from self-contracts—an agreement a student makes with himselfor herself (Klitzner et al., 1992)—to contracts made between the counselorand student (Donovan & Wasco, 1994).

3. Interventions. Interventions are based on assessments and contracts. Atthis stage, the problem-solving model does not prescribe any one theory,but instead incorporates techniques from theoretical frameworks andtechniques supported by research in other areas; theoretical frameworksinclude cognitive, behavioral, communication, task-centered, crisis inter-vention, family systems, and life models of practice (Donovan & Wasco,1994; Morehouse & Tobler, 2000a), and techniques include motivationalinterviewing (Gianmarco, 1997), and solution-focused methods (NSAA,n.d.). However, the matching of theories and techniques to student pro-blems has not been specified within the literature. Prevention counseling,using a problem-solving model, could incorporate relevant componentsof other science-based prevention approaches.Interventions within SAPs are carried out in a range of modalities includ-

ing individual, family, and group sessions (Donovan & Wasco, 1994;NIAAA, 1984; Wagner, Dinklage, Cudworth, & Vyse, 1999). One programwe reviewed, that of Morehouse and Tobler (2000b), provided an exten-sive set of groups foci (i.e., newcomers; seniors; children of substanceabusers; substance abusers; substance abusers who are also children ofsubstance abusers; alcohol and other drug assessment and education;and parents, peers, and partying). Parent support groups were also avail-able through an SAP parent program.

4. Evaluation. The evaluation determines the efficacy of student services. Inother words, counselors monitor students’ progress toward achievementof their respective goals (Klitzner et al., 1992). In its most basic form,the evaluation compares the extent of a student’s problems prior to and


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upon completion of the service. In sum, the evaluation determineswhether interventions were successful in decreasing problems identifiedduring assessment and in achieving the goals selected during contracting.Termination of service occurs when a student’s goals are achieved(Donovan & Wasco, 1994).

SAP activities are explicitly guided by a systems perspective (Donovan &Wasco, 1994; Koll, 1988) and this is evident in several different ways. First, byguiding the development of cooperative relationships with school personnel(i.e., faculty, administrators, and pupil services), community organizations,parent groups, and the students (Koll, 1988; NIAAA, 1983, 1984), use of thesystems perspective facilitates referral to and engagement of students in theprogram. For example, to identify students with problems and their sub-sequent engagement in services, student assistance counselors network withteachers and other key school personnel as well as make 10- to 20-minutepresentations in classrooms at the beginning of the academic year to intro-duce the program to students (NIAAA, 1984). Second, a systems perspectivehelps guide student assistance counselors in conducting a thorough assess-ment of students and their problems (e.g., program evaluated by Donovan& Wasco, 1994). Third, a systems perspective ensures the use of interventionsthat are culturally sensitive, with modifications of techniques based on socialclass, ethnicity, and cultural group (Morehouse & Tobler, 2000a; NIAAA,1984). Fourth, by guiding the development of cooperative relationships withcommunity-based human service agencies, the systems perspective aids inthe referral of students with severe problems to appropriate services in thecommunity, including 12-step self-help groups (Carlson, Hughes, LaChapelle,Holayter, & Deebach, 1994; Morehouse & Tobler, 2000a; NIAAA, 1983, 1984).

CURRENT RESEARCH FINDINGS ON EFFECTIVENESS OFSUBSTANCE ABUSE PREVENTION COUNSELING

Inclusion Criteria

Demonstrating the efficacy of intervention techniques requires the use ofrigorous research methodology. Several organizations, including the Centerfor Substance Abuse Prevention (CSAP), have enumerated criteria forscience-based substance abuse prevention programs. In reviewing theresearch on substance abuse prevention counseling, we used six criteriafor inclusion of research studies in our literature review. These six criteria are

1. use of an experimental or quasi-experimental design;2. use of samples drawn from middle school or high school;3. use of measures that focused on substance use, attitudes toward substance

use, or risk and protective factors;


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4. adherence to research design, sampling, and measurement procedures;5. statistical analysis appropriate to the research design; and6. successful completion of a peer review process.

We viewed criteria 1, use of an experimental or quasi-experimentaldesign, as most important because it provides the most support for acause-and-effect relationship between the independent variable (i.e.,program) and dependent variable (e.g., substance use, attitudes towardsubstance use, and risk and protective factors). Below is a summary of ourfindings for both school counseling and student assistance programs.

School Counseling

Research has played a minimal role in both the development of school coun-seling services and counseling-specific literature. Due to its developmentoutside of empirical psychology and human services, prevention counselingin school counseling has an exceptionally modest empirical base. Accordingto the National Center for School Counseling Outcome Research (2003),current initiatives in school counseling are only now beginning to frame testsfor its effectiveness in general. Furthermore, a recent Delphi study in the fieldmade no mention of substance use or abuse (National Center for SchoolCounseling Outcome Research, 2003).

Student Assistance Programs

Most investigations of SAPs have used extremely weak research methodologyand many are one-shot case studies (e.g., Koll, 1988; Wagner et al., 1999)measuring the performance of students only after they received services.Campbell and Stanley (1963) consider the one-shot case study the weakestdesign because it cannot determine what effect, if any, a program had onperformance. Therefore, we eliminated these studies from consideration.

Remaining studies were placed in one of three levels: Rigorous,Informative, or Evaluative. Rigorous studies met all of the six aforementionedcriteria. Using these criteria, we found three relevant studies for review(Apsler, Formica, Fraster, & McMahan, 2006; Jones, 2000; Kane, 1991).Informative studies utilized an experimental or quasi-experimental designbut had not undergone a peer review prior to publication. We found twostudies at this level (Morehouse & Tobler, 2000b; Pollard & Houle, 1993).Evaluative studies utilized weak research designs (i.e., one-group pretest-posttest design, static group comparison), but the researchers were explicitin describing their research methods and, therefore, merited a cursoryreview. There were five such studies at this level (Carlson et al., 1994;Donovan & Wasco, 1994; Richards-Colocino, McKenzie, & Newton, 1996;Scott et al., 1999; Wilburn, Wilburn, Weaver, & Bowles, 2007).


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It is important to note that although the literature on student assistanceprograms places substance abuse prevention counseling only within thecounselor model, a review of the empirical literature found programs labeled‘‘core team model’’ included interventions done by school staff or parapro-fessionals. We termed these programs ‘‘mixed models’’ because they utilizedinterventions and we included them in this section of the literature review.Within the SAPs reviewed, we found no direct tests of specific techniqueswithin the problem-solving model.

RIGOROUS STUDIES

Three investigations met the criteria to be considered Rigorous studies.Using a posttest only control group design, Apsler and colleagues (2006)evaluated the counselor model with two cohorts of sixth-graders. In themodel tested, counselors focused on enhancing protective factors, statingthat most risk factors (e.g., parental substance abuse) are not as amenableto change. All students in the intervention condition were placed inpsychoeducational groups, with a subset of seven students also receivingindividual support services. Compared to the control condition, studentsreceiving the intervention were more certain of how to find help, perceivedthat they had higher control over their lives, and placed more importanceon school. These students also believed that there are higher risks associa-ted with substance use and that use of alcohol and other drugs are wrong.Furthermore, these students held more certain plans to abstain from use inthe future. Although there were no significant differences between theexperimental and control conditions on substance use, the researchersattributed this to the low preexisting rates of use in this age group.(See Table 1.)

Jones (2000) used a non-equivalent control group design to comparestudents in SAPs from three schools with a mixed model (N¼ 60 students)to students from three schools without an SAP (N¼ 60 students). This SAPutilized both cognitive therapy and the elaboration likelihood model.Students in both groups were comparable in that both had used alcohol ordrugs. Jones found students in the SAP had less favorable attitudes towardalcohol and drug use and fewer disciplinary referrals. However, the authorfound no differences between the two groups on academic achievementand attendance. Alcohol and drug use was not measured and the sample sizewas small.

Using a non-equivalent control group design, Kane (1991) tested acounselor model by comparing an experimental group of students in theSAP (N¼ 44) to a control group of students (N¼ 40). In this investigation,the SAP was guided by a problem solving-approach. Although Kane foundthe experimental group had significantly fewer disciplinary referrals, therewere no significant differences between the two groups on the number of


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TABLE1

SummaryofRigorousStudies

Authors

Program

type

Staffcredentials

Research

design

Sample

Findings

Apsler,

Form

ica,

Fraster,an

dMcM

ahan

(2006)

CounselorModel

BA,5years’experience

ineducational

environment

Posttest

only

control

groupdesign

CohortI

6schools

N¼125

African

American20%

Hispan

ic16%

White49%

CohortII

4schools

N¼77

African

American:14%

Hispan

ic:15%

White48%

Overall:

N¼172

ControlN¼85

InterventionN¼87

More

certainofhow

tofindhelp

Had

ahigher

perceivedco

ntrol

overtheirlives

Placedahigher

importan

ceon

school

Higherperceived

risksofalco

holan

dotherdrugs

More

certainplansto

abstain

Beliefs

that

alco

hol

andotherdrugsare

wrong

Nodifference

insubstan

ceuse

288

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Jones(2000)

MixedModel

(core

team

and

counselor)

Notspecified

Non-equivalent

controlgroup

design

Experimental

3SA

Pschools

N¼60students

Control

3non-SAPschools

N¼60students

Less

favorable

attitudestoward

alco

holan

ddrugs

Fewerdisciplinary

referrals

Nodifferencesin

acad

emic

achievementor

attendan

ceKan

e(1991)

CounselorModel

Includeddistrictschool

psych

ologyinterns

andco

unselors

from

privatesubstan

ceab

use

facilitiesan

dprivatepractice;also

notedallwere

state-certifiedlicensed

professional

counselors.

Non-equivalent

controlgroup

design

Experimental

N¼44studentsa

mean

age¼13.5

45%

male

34%

White,59%

Hispan

ic,7%

African

American

Control

N¼40students

mean

age13.5

35%

White,60%

Hispan

ic,5%

African

American

Fewerreferralsfor

discipline

Nodifferencesin

numberoffailing

grades(D

s,Fs),

attendan

ce,or

suicidal

orientation

aFifteenreferredforoutsideorindividual

counselingan

ddisco

ntinuedgroupsessions.

289

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low grades (i.e., Ds and Fs), attendance, and suicidal orientation. However,alcohol and drug use were not measured and sample size was small, perhapstoo small to detect moderate and small effects. Furthermore, the posttestdata were collected for the period during which the experimental groupreceived services.

INFORMATIVE STUDIES

Morehouse and Tobler (2000b) tested the counselor model in alternativehigh schools. This model used a risk and protective factor framework as wellas the social development model. They used a sophisticated two-leveldesign—a pretest-posttest control group design to assess program effectson students receiving services within three schools with SAPs and anon-equivalent control group design to compare students in schools provid-ing SAPs with students in schools without an SAP. They concluded studentsin schools with SAPs had lower levels of drug and alcohol use when com-pared to students in schools without the SAPs. Their study also showed thatthese students had fewer substance-using friends. The students in these SAPsreceived a prevention education series followed by group or individualcounseling sessions. (Note: 8.6% of these students received only the edu-cation series.) (See Table 2.)

Pollard and Houle (1993), making no reference to a theoretical frame-work, found lower levels of substance use for students in SAPs. They useda non-equivalent control group design comprised of a sample of studentsin SAPs from five school districts (three using a counselor model and twousing a core team model) and compared them with students from one schooldistrict without an SAP (control group). They found no differences inoutcomes between students served by the two models. However, studentsreceiving services from SAPs showed lower levels of alcohol and drug useand better adjustment when compared with students from schools withoutan SAP.

EVALUATIVE STUDIES

Five evaluative studies were identified and each utilized a weak researchdesign. Of the studies examined, two found no increase in substanceuse, two found an increase in the number of abstinent students, andone found that students in schools with SAPs were significantly lesslikely to have had a drink in the past 30 days, tended to have fewerdrinks (including none) on a typical drinking occasion, and had highergrades (Carlson et al., 1994; Donovan & Wasco, 1994; Richards-Colocinoet al., 1996; Scott, Surface, Friedli, & Barlow, 1999; Wilburn et al., 2007).(See Table 3.)


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TABLE2

SummaryofInform

ativeStudies

Authors

Program

type

Staffcredentials

Research

design

Sample

Findings

Morehouse

and

Tobler

(2000b)

Counselor

Model

(alternative

highschool

setting)

Master’s-level

counselors

with

post-m

aster’s

experience

with

adolescents

Within

SAPsites

Pretest-posttest

control

groupdesign

Betw

eenSA

Pan

dnon-SAPsites

Non-equivalentco

ntrol

groupdesign

3SA

PSchools

N¼425(experimental

andco

ntrolgroups)

65%

African

American,

17%

White,6%

Hispan

ic,9%

Asian

,3%

NativeAmerican

2non-SAPschools

N¼102

Within

SAPsites(SAP

students

vs.non-SAP

students)

Less

alco

hol=otherdrug

use

Betw

eenSA

Pan

dnon-SAPsites

Less

alco

hol=otherdrug

use

Fewerusing

friends

Pollardan

dHoule

(1993)

Three

Counselor

Models

TwoCore

Team

Models

Notspecified

Across

SAPschool

districts

Non-equivalentco

ntrol

groupdesign

Betw

eenSA

Pan

dnon-SAPschool

districts

Non-equivalentco

ntrol

groupdesign

SAPschooldistricts

5schooldistricts

N¼1020students

44%

male

66%

White

Non-SAPschool

districts

1schooldistrict

N¼1513students

Across

SAPschool

districts

Nodifferencesbetw

een

Core

Team

Modelan

dCounselorModel

Betw

eenSA

Pan

dnon-SAPschool

districts

Less

alco

holan

ddrug

use

Betterad

justment

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TABLE3

SummaryofEvaluativeStudies

Authors

Program

type

Staffcredentials

Research

design

Sample

Findings

Carlson,

Hughes,

LaChap

elle,

Holayter,an

dDebach

(1994)

MixedModel

(core

team

and

intervention

specialists)

Teachers,

administrators,

staff

Intervention

specialist

(credentialsnot

given)

Onegroup

pretest-posttest

design

N¼1290students

Outcomedata

available

for943

students

(73%)

Increasedab

stinentstudents

Nodifference

inattendan

ce,

acad

emic

perform

ance,an

dschoolbehavior

Donovan

and

Wasco

(1994)

CounselorModel

Masterofsocial

work

with

substan

ceab

use

experience

Onegroup

pretest-posttest

design

3SA

PSchools

N¼54students

atpretest

N¼47students

atposttest

N¼45students

atfollow-up

Alcoholan

ddruguse

did

not

increase

Decreaseddepression

Increasedinternal

locu

sof

control

Increasedself-appraisal

of

problem-solvingab

ilityan

dproblem-solvingco

ntrol

Richards-

Colocino,

McK

enzie,

andNewton

(1996)

MixedModel(also

included

curriculum-

based

component)

Supportspecialist

–marriage

familyan

dch

ild

counselor

(MFCC)

candidateOR

personwho

held

pupil

personnel

credentials

Certificated

Coordinator

Single

group

pretest-posttest

design

Static

group

comparison

Experimental

N¼195students

(approx)

51%

male

71.2%

White,13.5%

Hispan

ic,6.5%

African

American,

7.7%

Asian

=Pacific

Islanders

145Fam

ilies

Control

N¼650students

48%

male

Decreasein

inhalan

tuse

Decreasein

risk

Decreasein

low

grades

Noch

angein

otherdruguse,

self-esteem,p

eerrelationships

Nosignifican

tch

angein

family

risk,cohesion,andadap

tability

Controlstudents

usedless

drugsan

dhad

higher

self-esteem

Controlfamilieshad

lowerrisk,

higherco

hesionan

dad

aptability

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68.9%

White,6.6%

Hispan

ic,2.8%

African

American,

22.5%

Asian

Pacific

Islanders

192Fam

ilies

Scott,Su

rface,

Friedli,an

dBarlow

(1999)

MixedModel

(core

team

and

parap

rofessional

group

counselors)

Teachers,staff

Parap

rofessionals

Static

group

comparison

Experimental

34SA

Pschools

N¼1384

Control

49non-SAPschools

N¼2070

Less

likely

todrinkin

past30

days

Highergrades

Nodifference

innumberof

drinksontypical

drinking

occasion

Wilburn,

Wilburn,

Weaver,an

dBowles

(2007)

CounselorModel

Trainedan

dlicensed

school-based

counselors

Mixedmethod,

non-experimen-

taldesignusing

repeated

measures

200schoolswith25

students

selected

from

eachsite

N¼2,238

62%

white

31%

African

American

7%

Hispan

ic50%

female

Statisticallysignifican

treductionin

mean

alco

hol

andotherdruguse

Increaseoftheinternallocu

sof

control

Reductionin

discipline

referrals

Nopositiveinfluence

ongrade

promotionorGPA

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DISCUSSION

Ideal SAP=Prevention Counseling Program Model and EvaluationDesign

Prevention counseling in student assistance programs is based on theproblem-solving model. This problem-solving model consists of four majorstages: assessment, contracting, intervention, and evaluation. When theprotocol for this model is followed, it is comprehensive and systematic yetflexible, and provides an internal test of its efficacy. It is considered compre-hensive because of its thorough assessment of each student and his or hersocial environment and its ability to select from a host of theoretical andempirical models to bring about change. It is considered systematic becausethe major stages remain the same across students and school settings, yet it isflexible because it adapts to the unique problems of a given student. Finally,the model provides an internal test of its efficacy because students areassessed before services begin and are evaluated after services are completedto determine if identified problems are resolved, remain the same, or becameworse. Because the problem-solving model utilizes a before-and-after com-parison, it includes a within-case test of its efficacy. If this before-and-aftercomparison is used in conjunction with clear operational definitions of tech-niques and modalities, and with reliable and valid assessment and evaluationinstruments, data can be aggregated within programs and enable cross-program comparisons—assuming consensus on measures. Consequently,because prevention counseling that follows the problem-solving modelincludes an evaluative component, it can lend itself quite easily to the estab-lishment of a protocol anchored in research.

Current Research Findings

Due to a paucity of research, there is an insufficient body of evidence todefinitively support or definitively challenge the use of substance abuseprevention counseling in schools. As noted above, we found no researchon substance abuse prevention counseling in the area of school counseling.In addition, only a small body of methodologically acceptable empiricalwork was found in the area of student assistance programs.

Within the level of Rigorous Studies, Apsler and colleagues (2006) foundimpact upon important protective factors; students receiving the interventionwere more certain of how to find help, perceived that they had highercontrol over their lives, and placed more importance on school. The resultsof the other two studies at this level, done by Jones (2000) and Kane (1991)were mixed and likely due to small sample sizes resulted in insufficient stat-istical power to detect differences, and neither examined alcohol or drug use.In the Informative Study group, the work of Morehouse and Tobler (2000b)


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in alternative schools and Pollard and Houle (1993) supports the use of SAPs.Their positive results are based on experimental and quasi-experimentaldesigns and demonstrate substance use was impacted. Within the EvaluativeStudies, the findings of Donovan and Wasco (1994) support using SAPs, butthe results of the other studies in this level are mixed. Nevertheless, all resultsin this classification are questionable due to the weakness of the researchdesigns used within these program evaluations.

A Methodological Critique

Although the Rigorous and Informative Studies used strong researchmethods, the remaining research (Evaluative Studies and those studies elimi-nated from our review because of weak designs) has several methodologicalproblems. Lessons learned from the literature review can inform both sub-sequent research on student assistance programs and research on substanceabuse prevention counseling in school counseling. With few exceptions, fivechief methodological problems exist in the Evaluative Studies and studiesexcluded. These problems include: a lack of clear operational definitionsof prevention counseling, weak research designs, lack of detail in sampledescriptions, scant use of measures for substance abuse and for risk and pro-tective factors, and rudimentary data analyses. Each of these methodologicalproblems merits a brief discussion.

OPERATIONAL DEFINITIONS

Operational definitions of prevention counseling are often absent or vague.Typically, the structure of the program and the services provided are notclearly articulated and the educational and professional credentials of itskey staff are not provided. Without this important information, it is imposs-ible to replicate and test a given program in other venues.

RESEARCH DESIGN

Far too few controlled studies utilizing a comparison group, let alone utiliz-ing random assignment, exist. In all studies we reviewed, only one used anexperimental design and only three used a quasi-experimental design. Fur-thermore, research designs did not account for the mediating, moderating,or interaction effects of control variables. The absence of random assignmentin these studies is problematic because it does not provide a clear picture ofprogram impact on student behaviors. Without the use of such designs andthe inclusion of control variables, it is impossible to definitively determinewhat caused a change: the prevention counseling program or other factorsin the social environment.


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SAMPLES

Descriptions of samples often lacked demographic detail with regard to suchbasic variables as age, gender, race, and ethnicity. In addition, the presen-tation of statistics regarding subject recruitment, elimination (e.g., excludingsubjects because they do not meet research criteria such as ‘‘no prior treat-ments’’), and attrition (i.e., drop-out) was either missing or unclear. Withoutsuch accounting practices, it could well be that a program is deemed effec-tive but only for highly specialized cases likely to succeed anyway.

MEASURES

Measures in two of the eight studies reviewed did not include an indicator ofalcohol or drug use. Although the importance of risk and protective factors inthe initiation and continued use of alcohol and other drugs has beenwell-established, few of the investigators assessed improvement in theseareas. Instead, some assessed attitudes toward alcohol and drug use, whichis not viewed as a good predictor of subsequent substance use or abuse.Given the need to address risk and protective factors, it is imperative thattheir levels also be assessed for each student.

ANALYTIC METHODS

In terms of analytic methods, many of the investigations used rudimentarystatistics and, as noted in regard to research design, did not take into accountthe mediating, moderating, or interaction effects of control variables. Eveninclusion of demographic variables, when available, would have beeninformative had they been incorporated into the statistical analysis.

While it is important to determine if a prevention program is effective, it isequally important to determine how it achieves its goals. We noted earlier inthis review that literature on prevention counseling, specifically derived fromthe school counseling tradition, indicates the relationship between the studentand counselor is a critical factor. Extensive empirical literature documents theimpact of this working alliance on outcomes for adults (e.g., Horvath, 1994).Unfortunately, we found no research on its impact on children and adolescents,let alone within the specific area of substance abuse prevention. Without suchinvestigations, it will be impossible to identify and improve the mechanismswithin substance abuse prevention counseling activities that lead to success.

This review of the literature identified the key elements of substanceabuse prevention counseling and found that research on its effectiveness isquite limited. The critical next step in establishing a rigorous research agendais to clearly define substance abuse prevention counseling across all ofits facets. To this end, an investigation consisting of three components issuggested.


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First, a survey to gather information on program components andprogram impacts would provide a baseline of prevention counseling charac-teristics to guide further study. These components are to include a determi-nation of staff education and credentials, program activities and programimpacts in terms of students served, and risk and protective factorsaddressed. Second, focus groups and key informant interviews in a sampleof prevention counseling sites should be conducted in order to gain descrip-tive information on program development, types of students served, thechange processes underlying services, and program outcomes. Third, caserecords should be reviewed at the current prevention counseling sites includ-ing data on students to provide information on demographics, assessments,service plans, and student progress. The information gathered would expandthe description of substance abuse prevention counseling and provide afoundation for future research.

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prevention counseling and student assistance programs: a review of the literature

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