Program

Jun 18, 2013

OVERVIEW

The Bicultural Competence Skills Program is a substance abuse prevention program designed to promote “fluency” in the two distinct cultures in which Native American children and adolescents live. The program trains participants in a variety of skills to promote social competence and positive identity. One experimental evaluation indicated that program participation had significant positive impacts on substance use, peer pressure resistance skills, and knowledge and attitudes towards substance use.  Another experimental study suggested that the program had a significant positive long-term impact on use of smokeless tobacco, alcohol, and marijuana.

DESCRIPTION OF PROGRAM

Target population: Bicultural (Native American) children and adolescents

The Bicultural Competence Skills Program (BCSP) is a substance abuse prevention program that uses skills training to promote “bicultural fluency.”  In addition to problem-solving, coping, and communication skills, the program teaches discrimination (skills related to avoiding temptation, and exploring healthy alternatives to substance use) through culturally-relevant examples that help the participants predict situations that would place them at high risk for substance abuse.

EVALUATIONS OF PROGRAM

Schinke, S. P., Orlandi, M.A., Botvin, G.J., Gilchrist, L.D., Trimble, J.E., & Locklear, V. S. (1988). Preventing substance abuse among American-Indian adolescents: A bicultural competence skills approach. Journal of Counseling Psychology35(1), 87-90. 

Evaluated population: A total of 137 Native American children and adolescents from tribal and public schools in two reservation sites in western Washington State participated in the study. The average age of participants was 11.8 years; 54 percent of the sample was female, and there were no significant differences between sites on demographic measures.

Approach: Participants were randomly assigned, by reservation site, into either a treatment or control group. Those in the control condition did not receive the Bicultural Competence Skills Program.

The program was administered over 10 sessions and led by two Native American counselors.  Coping skills were taught through strategies that included relaxation and self-instruction for handling pressure and avoiding situations involving substance use.  Leaders offered alternatives to substance use, and participants are taught to reward themselves subvocally (moving lips without actually speaking) when they make positive decisions and actions. Verbal and non-verbal ways to resist substance use were taught through examples , such as how to refuse offers of drugs, alcohol, and tobacco without offending non- Native American or Native American friends. Leaders gave feedback, praise, and coaching while participants practiced the skills. Social-network-building with friends, family, and tribal members who would encourage responsible decision-making on substance use was also demonstrated and practiced. To aid with this portion of the training, participants completed homework assignments following each group session. Participants were asked to support and monitor each other’s attempts at using the skills acquired through the intervention. Reports on homework were given at the beginning of the next group session and allowed for further discussions of social-networking steps.

To assess program effectiveness, data were collected on participants’ knowledge of health and social responses to peer influences on substance use, and self-reported substance use. Data were collected at baseline, immediately following the completion of the intervention, and at a six-month follow-up, post-intervention.

Results: At post-test, compared with the control group, program participants had significantly higher levels of knowledge about substance use and abuse, and had less favorable attitudes about substance use in Native American culture. Program participants were also rated as having significantly higher levels of self control, assertiveness, and alternative suggestions when facing peer-pressure to use substances. Smokeless tobacco use, marijuana use, alcohol use, and nonmedical drug use (all in the past 14 days) were significantly lower for the program group, as well.

At the six-month follow-up, impacts on knowledge were maintained, as were those for assertiveness, alternative suggestions, and self-control. Program participants also reported significantly lower past-two-week usage of smoked and smokeless tobacco, marijuana, alcohol, and inhalants, compared with the control group.

Schinke, S. P., Tepavak, L., & Cole, K. C. (2000). Preventing substance use among Native American youth: three-year results.  Addictive Behaviors 25(3), 387-397.

Evaluated population: Participants were 1,396 Native American students in 3rd through 5th grades, drawn from 27 tribal and public schools on 10 reservations in North and South Dakota, Idaho, Montana, and Oklahoma. The average student age at the beginning of the study was 10.28 years, and about half (49%) of the students were female. At the beginning of the study, 10-11 percent of students reported past-week cigarette smoking, 4-7 percent reported using smokeless tobacco, 9 percent reported using alcohol, and 6-7 percent reported using marijuana in the.

Approach: At the school level, students were randomly assigned to one of two intervention groups where they received either the skills version of the Bicultural Competence Skills Program, or the skills-plus-community-involvement version of the program. Other students were assigned to a control group.  Pre-intervention levels of substance use were similar among students in all three groups.

In both program versions, problem-solving, coping, and communication skills were taught by group leaders and demonstrated by older peers over fifteen 50-minute sessions during the spring school semester. Cultural content was used to highlight traditions that discouraged substance use, and to create role-play situations for students to practice discrimination skills.  Homework assignments encouraged students to find and engage with additional information related to substance use (e.g., the messages about tobacco and alcohol conveyed in advertisements).  The community involvement version of the program also aimed to get community members, like families, teachers, law enforcement, and businesses popular among young people, to support substance abuse prevention.  This component involved putting up posters around the community and offering informational sessions and activities to educate community members about the program and its message. Students also participated in two 50-minute booster sessions during each of the three years following the program.  Both program versions’ booster sessions involved training in age-appropriate skills, but the sessions for the community involvement program also included a community involvement component.

Students completed self-report questionnaires before the beginning of the program and 6, 18, 30, and 42 months after this pre-test, to provide information about their substance use (cigarettes, smokeless tobacco, alcohol, or marijuana) in the past week.  Saliva samples were also collected at each assessment point to increase the likelihood of honest self-reported tobacco use.

Results: Rates for smokeless tobacco use were significantly lower among students in the skills program group, compared with their peers in the control group or the skills-plus-community-involvement program group at the 30- and 42-month, but not the 6- and 18-month, follow-ups.  Similarly, alcohol use was also significantly less frequent among students in the skills program group than among their peers in the control group at the 30- and 42-month, but not the 6- and 18-month, follow-ups.  Students in the skills program group used marijuana significantly less often than their peers in the control group did at the 42-month follow-up, but not at any other follow-up points.  There was no significant program impact on students’ cigarette use at any of the follow-up points.

SOURCES FOR MORE INFORMATION

References

Schinke, S. P., Orlandi, M.A., Botvin, G.J., Gilchrist, L.D., Trimble, J.E., & Locklear, V. S. (1988). Preventing substance abuse among American-Indian adolescents: A bicultural competence skills approach. Journal of Counseling Psychology35(1), 87-90.

Schinke, S. P., Tepavak, L., & Cole, K. C. (2000). Preventing substance use among Native American youth: three-year results.  Addictive Behaviors 25(3), 387-397.

Contact information

Steven. P. Schinke
Columbia University School of Social Work
1255 Amsterdam Avenue
New York, NY 10027

Phone: (212)-851-2276

Email: schinke@columbia.edu

KEYWORDS: Children, Adolescents, Males and Females (Co-Ed), American Indian/Alaska Native, Clinic/Provider-Based, Skills Training, Social Skills/Life Skills, Tobacco Use, Marijuana/Illicit/Prescription Drugs, Alcohol Use

Program information last updated on 6/18/13

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