Rural Issues in Alcohol and Other Drug Abuse Treatment
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The process of networking to provide quality substance abuse prevention/early intervention services to high school students from across the Upper Peninsula (UP) of Michigan was formally undertaken in 1985. To maximize the limited financial and human resources available, a group of professionals from the major substance abuse service providers across the Peninsula decided to work collaboratively on a project called the Upper Peninsula Teen Leadership Program (UPTLP).
The UPTLP is a comprehensive prevention and early intervention program for high school students. It is a peer leader program that prevents substance abuse by strengthening resiliency factors. It promotes the concept that prevention is not something we can do to our teens, but something we must do with them, as partners. It consists of a variety of innovative student trainings held at different host school sites throughout the year. To meet students' needs for supportive adults and environments upon returning home from the regional trainings, school and agency personnel and community members also participate in workshops that are offered throughout the year to enhance the students' skills in working supportively with student leaders in their schools and communities.
Over the program's 9-year history, a strong network has emerged that includes professionals, community members, and students from all over the UP—a team enriched by the active participation of both Native American and non-Native American persons. The development of a team identity that occurs among the adult and student UPTLP partners is quite similar to the process described by Peter Senge in his book, The Fifth Discipline, regarding the development of aligned "learning teams." It involves (1) the ability to think in terms of "systems theory," (2) the development of a positive vision, (3) ongoing personal learning and growth, (4) the development of a sense of community and team, and (5) the willingness to explore new personal and/or agency paradigms, or "mental models."
These concepts and skills are purposefully incorporated into the UPTLP to provide a conceptual and programmatic framework in which a diverse group of professionals, community members, and high school students can see themselves as part of a larger system. Students and adults have ongoing opportunities for skill development and support that would otherwise not be available within isolated communities. The UP network has continued to work together over the years to meet new challenges and program needs. As a result of this continued collaboration, UP schools wishing to implement Student Assistance Programs have had ready access to necessary training, technical support, and some additional funding sources. Because of its successful history of promoting collaboration, the Marquette-Alger Intermediate School District has gained recognition throughout the State of Michigan and currently provides leadership in the development of a statewide student assistance network. Funded by several State agencies, this network has two tasks: . To develop a guidebook with recommendations for conducting Student Assistance Program trainings. The purpose of the trainings is to help prepare diverse groups of educators and community people to work together as aligned teams in their schools and communities. . To promote greater levels of alignment among State agencies involved with student assistance programs in the State.
Program resources have become increasingly scarce over the past few years. There is no question that the current quality and availability of services could not have been possible without the collaborative teamwork of this network of students, caring adults, and professionals. The UP network is not without gaps; however, it continues to grow in momentum, as well as in numbers.
This paper addresses the need for "strategies for coalition building and networking within rural and/or frontier areas." The UPTLP represents a collaborative effort by schools, agencies, and community members from across the entire UP of Michigan to provide a programmatic framework of training, resources, and support that can help to reestablish or enhance positive networks and linkages between individuals, families, schools, and other social systems. Its purpose is prevention: prevention of the onset or escalation of substance abuse and other self-destructive behaviors among UP teens and prevention of relapse for youth returning from substance abuse treatment services.
Although risk factors are identified and addressed at trainings, the major emphasis and strategies are directed toward developing internal and external protective factors that will help develop resiliency among our youth. This includes providing programming and networks designed to enhance a teen's internal assets (such as communication and coping skills and personal convictions) as well as to strengthen a variety of external assets (positive relationships in families, peer groups, schools, and community) (Troubled Journey: A Profile of American Youth, 1992).
The UP is an expansive area bordered by the southern shoreline of Lake Superior and the northern shoreline of Lake Michigan. It is connected to the Lower Peninsula only by the 5-mile-long Mackinac Bridge. The UP is rural, with a population density of 19 people per square mile. Its 16,500 square miles of land consist of wilderness and farmland, interspersed with isolated pockets of population. Although the UP represents just under 30 percent of Michigan's land mass, less than 4 percent of the State's population live there. The economy is dominated by mining, extractive industries, logging, and tourist trade. Layoffs and cutbacks have become a way of life to many residents, and a large segment of the population lives near or below poverty level.
UP communities, like rural communities in other parts of the country, have struggled to find ways to provide quality and cost-effective prevention and early intervention services to their youth. High-risk factors inherent in rural living include limited numbers of trained school and community professionals, scarce financial resources, and large distances between communities, which limit opportunities for supportive networking.
However, agencies and schools are committed to using these limitations as a motivation to share information and pool human and financial resources to make effective substance abuse prevention and intervention programs available to youth all over the area—in short, to network. This process was formally started in 1985. The result is a dynamic and effective UPTLP, a coalition effort making state-of-the-art prevention and early intervention programming available to youth and adults. Over its 8-year history, it has created a strong aligned team that includes professionals, community members, and students working together to promote leadership, resiliency, and positive lifestyle choices.
There are two aspects of the UPTLP's methodology to consider: . The UPTLP as a prevention and early intervention program for high school students . The UPTLP as a structural framework for networking and collaboration between school and agency professionals, parents, and community members and groups The methodology and the underlying philosophy that make the UPTLP effective as a youth prevention/intervention and aftercare support program also make it an effective vehicle for networking and coalition building among adults. Five major aspects of the program's methodology play a role in the powerful impact of the program in both arenas. They closely mirror the disciplines identified by Peter Senge in The Fifth Discipline as necessary components for the development of aligned learning teams:
The methodologies and contents of the UPTLP's prevention and early intervention program and its structural framework for networking and collaboration will be discussed separately.
It is important for youth to have an understanding of the skills and dynamics that determine whether a system (such as family, peer group, or school) will be "growth encouraging" or"growth discouraging." (These terms are preferred as they sound less accusatory than terms such as "functional" and "dysfunctional.")
Systems and Process ThinkingUnderstanding that there is a continuum of possible norms within different systems in each of these areas, it helps to lay a working foundation on which youth can build an understanding of how and why some systems are supportive and nurturing (growth encouraging) while others are stressful and emotionally painful (growth discouraging). They practice and learn skills that help them develop mutually supportive and respectful relationships with peers, family members, and other adults.
The UPILP functions throughout the UP and includes youth and adults from diverse backgrounds and communities. Periodic regional trainings provide formal opportunities for youth to get together for ongoing skill building and support.
Perhaps of equal importance, however, is the development of regionalpeergroups. Students forge deep bonds at the trainings; they tend to maintain the relationships as sources of motivation and support that bridge the time between trainings. This support is especially significant for students in rural areas who have limited choices of friends and peer groups.
A student returning home from chemical dependency treatment to a school that has only five to ten other students in the same grade faces difficult challenges when most, and possibly all, of these classmates use drugs. A peer group of close friends who understand and support a chemical-free lifestyle can make the difference in a youth's ability to remain sober, even if the group is spread across a large area.
A Positive VisionThere are two fundamental sources of energy that can motivate. . . fear and aspiration. The power of fear underlies negative visions. The power of aspiration drives positive visions. Fear can produce extraordinary changes in short periods, but aspiration endures as a continuing source of learning and growth.
Instead of conceptualizing prevention as something we do to our youth to prevent certain behaviors, we can think of it as something we do with them. As guides and partners, we can promote and support their development as resilient human beings and positive peer leaders.
In a study of more than 40,000 youth, grades 6 through 12, the Search Institute identified 20 protective factors. Of these, 14 were internal assets: communication skills, friendship-making skills, self-esteem, positive view of personal future, etc. A total of 16 were external assets: communication with parent(s) or another adult, positive school climate, positive peer influence, etc.
The institute's study "Troubled Journey" revealed that the more protective factors a child possessed, the lower the number of risk factors and high-risk behaviors. Other studies indicate similar correlations between strengthened protective factors and reduced levels of substance abuse.
In other words, prevention of drug and alcohol problems happens automatically if we focus our efforts on building resiliency and positive leadership skills in our youth. The primary prevention strategy used in the UPTLP develops teens' resiliency and positive leadership potential by strengthening internal and external protective factors.
Personal Learning and Growth The most significant learning takes place when an individual finds personal meaning or relevance in new information and skills and applies them practically to improve the quality of his or her life. When that happens, it is likely that a self-sustaining cycle will develop as achievements feed the motivation to continue learning and refining new skills.
Positive reinforcement keeps people involved as they grow and gain from their experience. The program's structural design encourages personal learning and growth. Large group presentations are interspersed with small "skill groups" in which students meet with two trained, adult facilitators. These skill groups provide time to process and integrate the information from the presentations. They also offer opportunities to practice both intrapersonal and interpersonal communication skills in a safe environment.
Many kinds of students from many different peer groups come to the UPTLP. Some are outgoing and some shy; some are athletes and some think that walking to the television constitutes exercise; and some have never touched a drop of alcohol or other drugs while some are working on their recovery. Increasing numbers of special need students (for example, physically handicapped or learning disabled) have participated in trainings over the years. The program has also included a large number of Native American students. Recognizing the special needs of the Native American students in the program has made increasing understanding of and respect for Native American culture, and multi-culturalism in general, important objectives of the program. The adults in the program also come from a variety of cultural and ethnic backgrounds. They include school and agency professionals, parents, and community members. The teens learn from their wisdom and experience. They discover that adults can be fun, caring, and helpful. In exchange, the adults learn from the teens' insights and energy; they discover that teens can be fun, caring, and capable of dynamic leadership. Imaginary lines that typically separate the adults from the youth and the "jocks" from the "geeks" and the "brains" seem to disappear as the participants learn more about each other as individuals. A sense of being valued as part of a diverse, yet cohesive, community and team develops over a weekend- or week-long UPTLP training. This development involves the following:
Mental Models
Youth are given opportunities to explore a variety of situations by applying new mental models. For example, by viewing how families function from a systems perspective, a youth can better comprehend interrelationships and dynamics of the "big picture." This leads to a fuller understanding of how certain behaviors might exacerbate problem situations at home or in school and, in the long run, be counterproductive. To maintain resilience throughout life, youth also need positive mental models for envisioning their personal futures and for dealing effectively with stress and conflict. The trainings and support network of the UPTLP allow youth to learn and practice these new models of perception and behavior.
UP Teen
Leadership
Trainings
More than 1,000 high school students and 500 adults participate in regional trainings at different sites over the course of the year. Each school or community has a contact person who provides followup and support to students after the trainings. Contact persons are also encouraged to work with students as advocates and advisors in the execution of action plans developed at the summer training and at other activities throughout the school year.
UP Teen Leadership Summer Training, the core training of the UPTLP, is a week-long program held on the campus of Northern Michigan University. A student assistance program training for school and agency professionals and community members is offered concurrently. It provides opportunities for adults and students to talk, work, and play together. Major presentation topics for students include "Understanding Family Systems," "Adolescence and Chemical Problems and Enabling," "Loss and Grief," "Intensity or Intimacy (Healthy Relationships)," "Yourselves," "Natural Highs," and "What It Means To Be a Leader."
Social competency and communication skills are taught through role play and rehearsal. Students practice these skills in realistic situations during skill groups. Students are taught reflective listening, assertiveness, decisionmaking, problem-solving, dealing with anger, and caring confrontation. A healthy environment is structured to model and encourage the development of responsibility, trust, respect for self and others, sensitivity to and celebration of individual differences, and ways to have chemical-free fun (see figures 1 and 2).
Teen Leadership PlP-Fest Weekends are booster programs offered several times each school year. PlP-Fests (Partners in Prevention Festivals) provide ongoing support and skillbuilding. Approximately 200 students and staff live in a high school for the weekend. They participate in presentations, skill groups, and recreational activities from Friday evening to Sunday afternoon. These weekends are very similar to the summer training in content and focus.
Athletic Chemical Awareness Programs are offered one to three times each year. They address some of the special needs, concerns, and opportunities that athletes have as leaders and powerful role models in their schools. Again, the underlying philosophy and training strategies remain consistent with the summer training. Role plays are used to explore concepts and practice new skills.
Mini-Training and Program Sharing Conferences are one-day programs at which 100 to 200 students and advisors share action plans and successful program activities.
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As previously noted, the methodology and the underlying philosophy that make the UPTLP effective as a youth prevention program also make it an effective vehicle for networking and coalition building among individual adults and agencies.
Systems and Process Thinking
UPTLP provides a structural framework for a systems perspective that encompasses the entire UP. The ability to view the UP as a suprasystem encourages agencies and community members to collaborate and network more closely in a common effort to make human and financial resources stretch further. The network includes professionals from all areas of substance abuse prevention, intervention and treatment services, education, mental and public health, social services, and the judicial system; parents; and community members.
Positive Visions
The UPTLP provides a foundational philosophy that helps keep the focus on one positive, shared vision: what we want for our youth. This positive vision of common goals and teamwork is nurtured and reinforced at all trainings.
Many of the adults who attend trainings or work as facilitators at the UPTLP also hold positions in schools and agencies, such as treatment centers and mental or public health clinics. As a result of the personal and professional growth they experience at the trainings, they bring increased levels of personal commitment and strengthened abilities in communication, trust, problem-solving, and negotiation back to their roles in the interagency network. The student and adult trainings provide a common educational and philosophical basis that helps encourage and equip diverse groups of people to cooperate as an aligned team working toward a shared vision.
Sense of Community and Team
In much the same way that a regional peer group develops among the teen leaders, a sense of community and team develop among the adults who participate in and staff UPTLP trainings. Professionals and community members who may have formerly found themselves at odds, perhaps in competition for funding, are much more likely and able to collaborate on win/win solutions when they see themselves as members of the same larger
community and team. As with the youth, authentic communication and the development of personal relationships constitute determining factors in the creation of a sense of community. Again, the relationships depend on knowing and caring about others both as individuals and as colleagues.
Mental Models
It demands great trust to set aside a mental model of "how things are" or "how things are done" and to really examine a situation through the eyes of another person or agency. When individuals identify themselves with a team of people they trust, respect, and share a vision with, their ability to suspend preconceived ideas and mental models is much greater. A team or network must achieve a level of trust before it can successfully use its resources to transcend individual and group mental models and seek new and creative solutions.
According to process evaluations of trainings and the subjective feedback of parents and school and agency professionals, the UPTLP appears to have had a strong impact on students. Staff feedback indicates that adults have also benefited greatly from the program. As a result of the trainings, both teens and adults have made major changes in their lives, such as quitting smoking or seeking treatment for chemical dependency.
On average, between 3 and 15 referrals are made at each weekend- or week-long training. Referrals to Protective Services are among the most common. Students are also referred regarding chemical use, suicide risk, and eating disorders. UPTLP staff provide followup to students, parents, and agencies, as necessary.
A followup evaluation of a PIP-Fest Weekend, conducted by the Substance Abuse Coordinating Agency in Ypsilanti, indicates that after a 6-month period, the majority (79 percent) of the students who participated in the PIP-Fest "believed they experienced a turning point during the weekend" that resulted "in a behavior change."
A formal evaluation of the UPTLP is currently under development. It will be conducted at four pilot sites and w ill measure the behavioral impact of the Teen Leadership Program as well as possible changes within the school climate.
Program strengths consistently mentioned in evaluations include a strong staff of skilled and caring adults; the creation of a safe environment where people can be "real;" and opportunites to learn about oneself and others, make new friends, and have fun! Students and adults also consistently identify the small skill groups as a critical component of the training experience.
A committee composed of adults and students from across the UP is currently evaluating ways to improve and expand the program. Possibilities include the provision of more extensive followup and support for students in every school and community. The level of involvement and support provided by the identified school contact person varies from district to district. Although staff and network members of the UPTLP are available to all districts and communities for support, presentations, and inservice trainings, not all districts have availed themselves of the services. In addition to some new types of weekend trainings, possibilities for new parent and community service components that enhance teen linkages to families and communities are currently being explored.
The UPTLP currently has seven financial cosponsoring agencies: the Substance Abuse Prevention Program (SAPE-UP) at the Marquette-Alger Intermediate School District, which coordinates the program; both UP substance abuse prevention coordinating agencies, all three Michigan Model Comprehensive School Health Programs of the UP; and Northern Michigan university. Numerous other agencies (such as Community Mental Health and Department of Social Services) and local school districts provide staff for trainings and scholarship money for students.
Recognition is also due the Partners Institute and PIP-Fest, Inc., both of Minnesota. Much of the training methodology and philosophy used by the UPTLP originated with these programs. The UP coalition network continues to include a number of these program professionals from Minnesota and has even added a few members from Wisconsin and Canada. eir involvement as added a healthy outside perspective and fresh energy.
Approximately 6 years ago, student assistance programs began to pick up momentum as a viable means of providing comprehensive prevention, intervention and referral, and aftercare support services to students and families. An aligned network, with a history of successful interagency collaboration to draw upon, was already in place. It helped to provide trainings, technical support, and funding to school districts throughout the UP. This contributed greatly to the professional community's ability to respond quickly to districts' needs to develop and implement student assistance programs.
The UPTLP has proven extremely effective as an organizational structure that provides an avenue of involvement, shared leadership, and recognition to a diverse and geographically dispersed group of individuals and agencies. The network is not perfect. There are still gaps, challenges, and occasional areas of resistance. However, the members of this network provide a great deal of support to each other. They remain extremely committed to addressing the problems and improving the availability and quality of substance abuse services in the UP. They also recognize their place in a much larger system and realize that their ability to fill in the gaps and meet the challenges is part of an ongoing process.
The UPTLP provided an initial structure to organize a diverse group of stakeholders into a functional network. The nature of its programmatic philosophy and training strategies encouraged the development of systems thinking, provided positive vision and personal learning, suggested alternatives of new mental models for seeing and doing things, and promoted a sense of community identity among participants. The work of Peter Senge has been very helpful in understanding reasons why a strong, collaborative network of professionals and community members seemed to simply emerge as a natural result of cooperating on the program. The answer lies partly in the fact that the five disciplines identified by Senge as essential for the establishment of an aligned learning team are also at the foundation of effective prevention programming. The UPTLP incorporated all five disciplines without having any conscious awareness of their potential power to foster the development of such a strong and expansive network.
Because these five disciplines have been shown to be effective in building collaborative networks and teams, they are being used as the methodology for working with a committee of 50 stakeholders involved with student assistance across the State of Michigan. This committee includes representatives from such diverse groups as the Office of Drug Control Policy, the Department of Education, the Department of Social Services, Community Mental Health, the Center for Substance Abuse Services at the Department of Public Health, Michigan DARE, Michigan PTA, school administrators and teachers, counselors, and student assistance trainers. It has undertaken two tasks:
Since its beginnings 9 years ago, the UPTLP has provided many valuable lessons on effective prevention and early intervention and networking. Perhaps the most significant lesson teaches that good design and content are not enough. Ultimately, it takes good people and relationships to make good programs. This also holds true for developing an interagency coalition or network. In the building of truly functional, collaborative networks in rural and frontier areas, the primary investment of time and energy must go into developing human resources and relationships; problem-solving and the creative identification of financial resources will follow. Specific recommendations arising from the experience of UPTLP include the following:
In addition to helping build a common philosophical and informational base from which to work, the trainings also provide an opportunity to gain necessary skills and learn how to use the five identified disciplines. When used together as conscious methodology, these disciplines seem to have a synergistic effect: systems and process thinking plus personal learning plus mental models plus sense of community equals aligned teams and reduced levels of fragmentation. Reduced levels of fragmentation equal more effective use of human and financial resources; more support; and effective prevention, intervention, treatment, and aftercare support programs. Collaborative networks help reestablish and strengthen linkages between individuals and organizations. They are effective because they capitalize on the fact that all of us, together, know more and can do more as cohesive members of an aligned team than any of us can do alone, providing fragmented services as individuals or agencies. Furthermore, networks empower individuals and agencies; they offer opportunities for shared input, shared decisionmaking, shared responsibility, and shared recognition. Everyone wins—especially our youth!
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