SHAHRP
School Health and Alcohol Harm Reduction Project
International Bulletin:
What is the SHAHRP program?
The School Health and Alcohol Harm Reduction Project is a world first research study assessing the behavioural impact of classroom-based alcohol harm reduction on students' alcohol consumption and harm in alcohol use situations (Scientific Publications). The study was conducted over a 32-month period from baseline, with earlier data collection at 8 and 20 months after the completion of each phase of the program (Research Design). Each assessment measured: knowledge about alcohol; attitudes towards alcohol; total consumption, risky patterns of consumption, context of alcohol use, alcohol-related harms/risks associated with the student's own alcohol use, and alcohol-related harm/risks associated with other people's alcohol use.
The evidence-based, classroom program was conducted in two phases over a two year period. The initial phase was implemented during the first year of secondary school when most students were 13 years old. It consisted of 17 skill-based activities conducted over eight to ten lessons. Phase 2, which was conducted in the following year, consisted of 12 activities delivered over 5-7 weeks.
The Results
The SHAHRP results indicated an immediate effect in reducing the harm from young people's own drinking, and the harm they experienced from other people's drinking. Over the period of the study (from baseline to final follow-up 32 months later), students who participated in SHAHRP consumed 20% less alcohol, were 19.5% less likely to drink to harmful or hazardous levels, had a 10% greater alcohol related knowledge, experienced 33% less harm associated with their own use of alcohol and 10% less harm associated with other people's use of alcohol than did the control group (who received regular alcohol education).
During the first and second phases, intervention students consumed 31.4% and 31.7% less alcohol. Differences in alcohol use were converging 17 months after the end of the program. Intervention students were 25.7%, 33.8% and then 4.2% less likely to drink to risky levels from first follow-up onwards. However, the impact on harm reduction was maintained. The intervention reduced harm that young people experienced as a result of their own use of alcohol, with intervention students experiencing 32.7%, 16.7% and 22.9% less harm from first follow-up onwards.
These findings are important given that school based drug education is often criticised for not impacting on young people's behaviour.
What is the SHAHRP classroom program?
SHAHRP is a classroom based program aimed at reducing alcohol-related harm and risky consumption. SHAHRP is designed to be implemented at a time when local prevalence data indicate that young people are starting to experiment with alcohol.
Before developing and pre-testing the program, project staff conducted extensive formative work, including talking about alcohol issues with young people, to ensure that activities were based on reality and relevant to young people (Publications: 2, 9, 13). The program is evidenced-based in that it incorporates findings from a systematic literature review of school drug education research (Publications: 5, 7), incorporates the experience of young people, and has been well tested in schools with students and teachers.
The SHAHRP activities incorporate various strategies for interaction including delivery of utility information; skill rehearsal; individual and small group decision making; and discussions based on scenarios suggested by students, with an emphasis on identifying alcohol-related harm and strategies to reduce harm. Interactive involvement is emphasized, with two-thirds of activities being primarily interactive and another 15% requiring some interaction between students. Interactive involvement of students provides important practice in reducing harm associated with alcohol use and is a critical aspect of lessons using an evidence-based approach.
The SHAHRP program components include:
Teacher training
Teacher training is conducted before each phase of SHAHRP. During Phase One, teachers are provided with two days of training to provide an overview of the study behaviour outcomes, evidence-based components, and interactive modelling of each Phase One activity. Phase Two training is conducted over two days for teachers new to the Project. These teachers are briefed on the research aspects of the Project and Phase One intervention activities during the first day of training. On day two, all teachers participate in interactive modelling of Phase Two activities. Trainers who are experienced in interactive techniques are recommended as SHAHRP teacher trainers.
Teacher manual
The teacher manual provides specific written guidance for teachers. The manual included detailed and structured lesson plans for eight 60-minute lessons in the First Phase and seven 50-minute lessons in the second phase. Each lesson plan includes sample questions to help facilitate discussion and debriefing of activities, coaching points to aid in the management of the activities, and background information about alcohol-related issues. Additional coaching points included in the teacher manual are based on feedback from teachers who have previously taught the program.
Student workbooks
Student workbooks (phase 1 and phase 2) are available for each phase to stimulate and engage student's interest, provide information, encourage students to further explore issues and to record what they have learned as a way of consolidating practical activities. Qualitative results from the SHAHRP study show that students and teachers thought the books were appealing and great to use as reinforcement to the interactive activities.
Trigger video
The 'Lets Look At' trigger video from the Rethinking Drinking resource (Youth Research Centre 1995) was used in Phase Two. The video featured scenarios that young people may experience in alcohol use situations to prompt discussion about how to minimize the harms associated with alcohol use.
The SHAHRP teacher manual and student workbooks are available free from the SHARHP website.
Formative Development of the SHAHRP Program
During the development of SHAHRP, particular attention was given to ensuring the program was based on the latest evidence by incorporating results from a systematic literature review of school drug education; was appropriate and relevant to young people by incorporating realistic scenarios and situations based on focus groups conducted with young people, and was tested with teachers and students in real life and incorporated modifications to make the program workable in schools (Publication: 2).
Focus Groups
The process of engaging students has been given particular emphasis during program development. To ensure that the SHAHRP intervention was sensitive to the concerns of the students it sought to influence, the SHAHRP researchers conducted a series of focus groups with 80 Western Australian teenagers. Students were allocated to the focus groups based on gender. The focus groups aimed to identify young people's alcohol use experiences, alcohol related harms of particular concern to young people, harm reduction strategies adopted by young people, and educational approaches likely to be effective with young people.
The students were generally keen to express their opinions about alcohol and issues associated with its use by young people and were consistent in the issues they identified as of concern to them (Publications: 2, 9, 13).
Piloting Intervention Program
Pre-testing of the alcohol program played an important role in refining the alcohol curriculum materials to incorporate teacher and student responses, while maintaining the integrity of the evidence-based components. Three Western Australian secondary schools were recruited to pilot the alcohol intervention. The program was implemented in six year eight classes (12 - 13 year olds) involving approximately 200 students and six teachers. Before implementation, pilot teachers attended a two day training workshop based on interactive modelling of intervention activities. Pilot teachers provided written and verbal evaluation of this workshop.
Process evaluation and monitoring procedures were also piloted during this initial formative stage of the study. Pilot teachers were asked to complete a process evaluation form for each activity immediately after conducting the lesson. The process evaluation forms required comment on level of completion, student response, teacher response and suggestions to retain or modify each activity. Forms were provided to the researcher immediately after completion of each lesson. This information provided an ongoing list of suggested modifications and impressions that were used to revise the intervention before the main study.
Evaluation Workshop
An evaluation workshop was conducted at the conclusion of the pilot to further refine the teaching program. The workshop was attended by the pilot teachers, the primary writer of the program, and the SHAHRP research team. A triangulation of measures was adopted to assess the program including teacher and student monitoring. Each activity in the program was discussed and assessed by the pilot teachers, according to content, methods, relevance to age, timing and training. The process evaluation forms, which required comment on level of activity completion, student response, teacher response and suggestions to retain or modify for each activity, were reviewed. Each teacher also provided written student comments regarding what the students liked and disliked about the program and recommendations for improvements.
These recommendations were incorporated into the SHAHRP teaching program. One of the most valuable aspects of the pilot process was 'putting the materials to test in the real world' of the classroom, thereby gaining insight into the potential effectiveness of the harm reduction program that incorporated evidence.
Cost: The cost of implementing the SHAHRP program in schools is relatively low once teacher training has been completed.
Document reference: McBride, N. (2008). International Bulletin: The School Health and Alcohol Harm Reduction Project (SHAHRP). An Evidence-based Program to Reduce Alcohol Related Harm in Young People. National Drug Research Institute, Curtin University, Perth, Western Australia.
Teachers and Students Comments
Overall a very refreshing project to be involved with. I thoroughly enjoyed teaching the unit and I enjoyed the student's response and how much they got out of it. Congratulations on producing something that is relevant, improves the Health Education course and has a chance of affecting their behaviour in a positive way. (Teacher)
Copyright release: Copyright release of the SHAHRP program is available free, however there are some conditions.
Why focus on alcohol? Within a period of about 10 years, young people change from individuals who have never had an alcoholic drink to individuals who, as an age group, are the heaviest drinking section of the population.
What can schools do to help young people in alcohol use situations? Well designed school drug education can be an important element within a community approach to youth drug issues, and this is supported through systematic examination of the literature.
Harm Reduction versus abstinence approach to school drug education: The North American dominance in published evaluations about school drug education has directed the field toward an abstinence approach for many years. However, a high proportion of young people continue to drink alcohol and experience harm from alcohol use.
