3.1 New national strategies and goals
In the government’s action plan to combat drug and alcohol-related problems 2006-2008 (chapter 1.2.2) the prevention of all types of drug and alcohol-related problems, with particular focus on pre-ventive efforts among children and young people, is mentioned as an important strategic goal. It is stated that the prevention of drug and alcohol-related problems must be viewed more in conjunc-tion with general prevenconjunc-tion. The methods used to prevent and intervene early against behavioural problems at school, such as bullying or smoking, or measures to prevent and intervene early against criminal behaviour, also prevent drug and alcohol-related problems. Drug and alcohol-related pre-vention efforts must therefore be integrated to a much greater extent with the rest of the preven-tive and support services.
Four target areas in the action plan:
1) The field of prevention will be reviewed, and a plan will be drawn up that describes how coop-eration between the authorities and voluntary organisations can best be achieved.
2) In the action plan emphasis is placed on strengthening early intervention efforts aimed at chil-dren and young people at risk, chilchil-dren of parents with drug and alcohol problems and chilchil-dren and young people from immigrant backgrounds. The plan also maintains that it is necessary to focus more on prevention and early intervention in connection with drug and alcohol-related problems in the workplace.
3) The government believes that it is necessary to increase expertise in identifying children of drug and alcohol abusers, and increasing knowledge about the special needs of children who live with parents with drug and alcohol problems. A pilot project has been instigated for the sys-tematic testing and development of interventions in selected municipalities in order to follow up children whose parents have drug and alcohol problems. Guidelines are also being prepared for agencies that provide services to adults with drug and alcohol problems and persons with mental health problems, to ensure that the children also receive the necessary help. The gov-ernment will carry out systematic testing and development of interventions in treatment insti-tutions in which children accompany their parents during treatment.
4) A research project will be instigated for children and young people from immigrant back-grounds in order to find out more about how MST (multisystemic therapy) works in such fam-ilies. In our experience, such interventions have a good effect in relation to Norwegian families with children with behavioural problems (Ministry of Labour and Social Affairs, 2005).
3.2 Universal prevention
Interventions in schools
Schools are an important arena for preventive work in Norway. Drugs and alcohol education is based on a set curriculum and is an integrated part of ordinary tuition. It is a common feature of the school programmes and interventions that are implemented in schools that they primarily influence factu-al knowledge about drugs and factu-alcohol, while it is difficult to identify any effect on behaviour.
Roughly 90 per cent of schools implement one or more school programmes. Other measures which
schools have used in order to prevent serious behavioural problems and contribute to the develop-ment of social competence come in addition (structured questionnaire 22)4.
The Directorate for Health and Social Affairs is working on a knowledge base and on developing a strategy for bringing together and coordinating drug and alcohol prevention efforts in schools (see chapter 1.2.4).
The Directorate for Primary and Secondary Education has drawn up a comprehensive plan for the environment in which young people learn and grow up 2002-2005: “A secure and stimulating envi-ronment in which to learn and grow up”. Preventive measures are one of three important target areas. The Directorate for Primary and Secondary Education has produced two brochures: “Serious behavioural problems – on prevention and mastery in schools”. The brochures provide guidelines for school owners, school managements and teachers on work with children who are in the danger zone, in relations to drugs and alcohol, among other things.
Evaluation of the Drugs and Alcohol Helpline (RUStelefonen)
The Drugs and Alcohol Helpline is a service for those who wish to obtain factual information and advice about drugs and alcohol and related abuse, as well as advice about the treatment of such abuse. The main target group consists of young people who experiment with drugs and alcohol and their families. The helpline is run by the Oslo Drug and Alcohol Addiction Service on assignment from the Directorate for Health and Social Affairs. It is a three-year project scheduled to run from 2003 to 2005. During 2005, the Directorate for Health and Social Affairs will consider whether to continue the service and whether to make any changes in its operation.
The Drugs and Alcohol Helpline was evaluated by the University of Oslo in spring 2004. The evalu-ation includes a description of the system, an evaluevalu-ation of goal attainment, user satisfaction and the population as a whole and the target group’s familiarity with the service. The evaluation shows that 41 per cent of callers were men, while 59 per cent were women. Family members accounted for 36 per cent of the calls, while only 18 per cent fell into the category “young drug and alcohol abusers”. Of the conversations, 4 per cent were described as support and guidance conversations with young people. The evaluation concludes that callers were satisfied with the conversation with the Drugs and Alcohol Helpline counsellors. Those who sought advice were most satisfied, while those who wanted factual information were less satisfied.
Evaluation of AKAN
AKAN – the Tripartite Committee for the Prevention of Alcohol and Drug Problems in the Workplace – which was established in 1963, is a tripartite collaboration between the Norwegian Confederation of Trade Unions, the Confederation of Norwegian Enterprises and the state. The purpose of AKAN is to combat drug and alcohol-related problems in Norwegian workplaces, to enable managers and employees to intervene in connection with risky drug and alcohol use, and to help employees with drug or alcohol problems to obtain assistance. Efforts are aimed at all workplaces in Norway both in the private and public sectors and in large and small enterprises. Almost two out of five employ-ees work in enterprises with a drug and alcohol prevention service organised in accordance with the AKAN model, and AKAN is represented in all industries and business sectors.
AKAN’s activities have been evaluated by the Work Research Institute on assignment from the Directorate for Health and Social Affairs. The main findings show that AKAN should continue with its basic model. In order to meet new challenges, AKAN should develop its service and play a more dynamic and proactive role. Establishing and running an AKAN service requires resources, and the
AKAN model is used less by small enterprises. AKAN should therefore develop its methods in order to reach new groups in the workplace (Frøyland, Grimsmo og Sørensen, 2005).
3.3 Local community-based prevention
See information in structured questionnaire 25.
The ongoing regional project is part of the government’s action plan to combat drug and alcohol-related problems (2003-2005) (NR 2004 chapter 3). The overriding goal is to reduce the prevalence of drug and alcohol use and the harmful effects of the use/abuse of drugs and alcohol by strength-ening preventive efforts at the local level. The project is based on a model for local community-based prevention that comprises a number of different measures and strategies that are adapted to local needs and instigated simultaneously. The project is unique in the Norwegian context. The Directorate for Health and Social Affairs has overall responsibility for the project, which is evaluated by SIRUS.
The evaluation consists of a process evaluation and an effect evaluation. The final evaluation report will be completed in spring 2007. On the basis of the evaluations, it will be considered whether it is desirable and expedient to extend the model used by the regional project to also include other municipalities. SIRUS has written a method memorandum on the evaluation.
School surveys are an important source of evaluation data in the regional project. The first school survey, which was conducted in autumn 2004, comprised all students in all years of lower second-ary school and upper secondsecond-ary school in both the project municipalities and the control munici-palities. The students complete a questionnaire at school (during school hours). A corresponding questionnaire survey of all six school years is conducted one and two years after the baseline survey.
The process evaluation analyses how the signals from central decision makers are translated into practical action in the municipalities. Qualitative interviews, observation and document studies show how the professional and financial support provided to project municipalities results in local priori-ties. The process evaluation also focuses on how variation in local framework conditions results in differences in the design, implementation and maintenance of various preventive measures.
3.4 Selective/indicated prevention
See information in structured questionnaire 26.
The Government’s action plan (2006 – 2008) emphasises the situation of children as a particularly important target area, and the Government wants to increase efforts to enable intervention to take place as early as possible. An overriding objective, and one of the main tasks in work with problem drug and alcohol users, is early intervention and in particular better efforts aimed at children and young people at risk.
National strategy for early intervention against problem drug and alcohol use
The Directorate for Health and Social Affairs has been assigned responsibility for drawing up a pro-gramme for prevention and early intervention. The propro-gramme is based, among other things, on experience from a research project into drugs and alcohol and the workplace and a report on “The responsibilities of the primary health service in drug and alcohol treatment and preventive drug and alcohol efforts”. Together with the drug and alcohol competence centres, the Directorate for Health and Social Affairs will develop a national strategy for early intervention against problem drug and alcohol use. The strategy will be very similar to secondary or selective prevention, but the prevention will specifically target risk groups before drug and alcohol problems arise, and early intervention will
Help for children of parents with mental health problems or drug and alcohol problems
The Directorate for Health and Social Affairs will draw up guidelines for agencies that provide serv-ices to adults with drug and alcohol problems and persons with mental health problems, to ensure that the children also receive the necessary help.
Systematic work with small children in risk families
In cooperation with the national childcare services, the Directorate for Health and Social Affairs will evaluate experiences from systematic work targeting families at risk with small children, in Norway and possibly in other countries, with a view to formulating recommendations for implementation on a national basis.
Multisystemic therapy (MST)
MST is a method of treatment that targets young people aged between 12 and 18. The method entails close follow-up of the individual youths involved, their families and local environment. The treatment is given through the child welfare and family welfare services. Training started in 1998, and so far the evaluation results are positive. Research from the USA shows a considerable reduc-tion in behavioural problems, including drug and alcohol problems, both at home and in school.
MST has been developed as a method by MST Services and the Medical University of South Carolina in Charleston, USA. In Norway, the implementation and follow-up/quality assurance work is led by the Behavioural Centre – Unirand, which is wholly owned by the University of Oslo. The MST teams are organised under the child, youth and family services in the five regions.
MST is being evaluated in three counties. The purpose is to throw light on what young people between the ages of 12 and 17 with behavioural problems, and their families, gain from MST or child welfare measures under the auspices of the county authorities. The 100 young people involved and their families were randomly assigned to MST (N=62) and other measures under the auspices of the child welfare services (N=38). Data collection started in 2000, and the young people were registered on admission, and followed up after approximately six months and two years. The most important causes were crime, alcohol and drug abuse, unauthorised absence from school, running away from home and other serious behavioural problems. 44 per cent had three or more referral reasons and 39 per cent has previously been placed outside the home. The average age of partici-pants in the project was 15 years, and 37 per cent were girls.
Participation in the evaluation project was voluntary, and the families were paid a small compensa-tion for completing the quescompensa-tionnaires. 96 families took part in the follow-up after six months, while 89 took part after two years. The results of the evaluation have yet to be published.
Cause-for-concern interviews
The Ministry of Justice and the Police has drawn up guidelines for the police’s carrying out of cause-for-concern interviews with children and young people, particularly with a view to involving parents when law breaking or other risk behaviour is discovered in children under the age of 15. The police’s cause-for-concern interview with young people who behave in a way that empirically entails a great risk of law-breaking and negative developments is an important measure.
3.5 Prevention database
The database is part of the website www.forebygging.no, an interactive arena for prevention and health promotion work in Norway (see NR 2004 chapter 3.2.5). The database is intended to pro-vide an overview of Norwegian drug and alcohol prevention measures, to document the use of var-ious drug and alcohol prevention activities and to increase expertise in evaluation. The website will
highlight prevention measures that can document results of their work in order to focus on the good examples. The method used is an interactive registration form with a pertaining learning tool on evaluation linked to a searchable database. The development work will be completed in autumn 2005, but the website has already been in operation since January. So far, the database comprises 74 projects, 44 of which are national (www.forebyggingstiltak.no).
3.6 Continuing education
Continuing education for social workers and health personnel was discussed in NR 2002 chapter 9.4 and NR 2003 chapter 9.2.
Continuing education in outreach work was described in NR 2004 chapter 3.2.4. The education is a collaboration with Oslo University College, the National Association of Outreach Workers and the Oslo Drug and Alcohol Addiction Competence Centre. Its primary goal is to increase knowledge and skill levels in outreach work through comprehensive and systematic training. The first class – 17 students – completed the course in spring 2004. A new class with 25 students started in September 2005.